scholarly journals An uncommon manifestation of Streptococcus gallolyticus infective endocarditis with cerebral septic emboli

2017 ◽  
Vol 4 (4) ◽  
pp. 16
Author(s):  
Wan Tin Lim ◽  
Chiara Jiamin Chong ◽  
Robert Chen ◽  
Tharmmambal Balakrishnan
Keyword(s):  
Infective Endocarditis ◽  
Intracranial Hemorrhage ◽  
Cerebral Arteries ◽  
Neurological Manifestations ◽  
Septic Emboli ◽  
Streptococcus Gallolyticus ◽  
Uncommon Presentation ◽  
Magnetic Resonance Imaging Mri ◽  
Occipital Lobes ◽  
High Degree

Infective endocarditis (IE) can often present with neurological manifestations, due to embolization from valvular vegetation, but the presentation is often variable and unpredictable. Septic emboli to both occipital lobes supplied by the posterior cerebral arteries, resulting in visual disturbances are also an uncommon presentation of IE reported in the literature. While S. gallolyticus is a classical cause of IE, it is less common and usually occurs in a less suspecting group of patients with no predisposing cardiac conditions. We report the case of a 48-year-old man, who presented with predominant complaints of blurring of vision and temporal headache, without any other infective symptoms. The procalcitonin level was also normal even in the setting of bacteremia with septic embolism. The initial magnetic resonance imaging (MRI) showed multifocal enhancing lesions in cerebral hemispheres, cerebellum, and brainstem, with leptomeningeal enhancement. Transesophageal echocardiography and blood cultures subsequently confirmed diagnosis of S. gallolyticus IE of the mitral valve. The patient was treated with antibiotics upon diagnosis of IE. However, he developed intracranial hemorrhage secondary to mycotic aneurysms, and partial seizures. He eventually succumbed to the intracranial hemorrhage. This case serves to highlight that neurological manifestations can precede symptoms or signs of IE and the presentation are often variable. A high degree of clinical suspicion is needed to suspect neurological manifestations of IE, especially in patients without risk factors.

scholarly journals Reversible Cortical Blindness as a Prominent Manifestation of Cerebral Embolism due to Infective Endocarditis

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Georgios P. Kranidiotis ◽  
Alexandra N. Gougoutsi ◽  
Theodoros A. Retsas ◽  
Maria I. Anastasiou-Nana
Keyword(s):  
Infective Endocarditis ◽  
Visual Loss ◽  
Cerebral Arteries ◽  
Multiple Organ ◽  
Cortical Blindness ◽  
Multiple Organ Dysfunction ◽  
Case Presentation ◽  
History Of ◽  
Occipital Lobes ◽  
The Brain

Introduction. Infective endocarditis in the left heart may be complicated by stroke, due to embolisation from infectious valvular vegetations. Infarction of both occipital lobes, which are supplied by the posterior cerebral arteries, is infrequent, and is the cause of cortical blindness from lesion of the visual cortex. Cortical blindness is characterized by intact pupillary reflexes, a normal fundoscopy, and, rarely, denial of visual loss.Case Presentation. We report the case of a 58-year-old woman, recipient of a mechanical aortic valve, who presented with fever, multiple organ dysfunction, and cortical blindness. Transesophageal echocardiography and blood cultures confirmed the diagnosis of infective endocarditis caused by methicillin-sensitiveStaphylococcus aureus. Computed tomography of the brain without contrast revealed the presence of infarctions in both occipital lobes. It is noteworthy that the visual loss resolved after treatment of endocarditis.Conclusions. A stroke occurring in a patient presenting with fever and a history of valvular heart disease strongly suggests the presence of infective endocarditis. Bilateral thromboembolic infarcts of the occipital lobes cause cortical blindness, that can resolve after treatment of endocarditis.

scholarly journals A deep learning method for automatic segmentation of the bony orbit in MRI and CT images

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jared Hamwood ◽  
Beat Schmutz ◽  
Michael J. Collins ◽  
Mark C. Allenby ◽  
David Alonso-Caneiro
Keyword(s):  
Deep Learning ◽  
Human Performance ◽  
Automatic Segmentation ◽  
Ct Images ◽  
Human Observer ◽  
In Series ◽  
Magnetic Resonance Imaging Mri ◽  
High Degree ◽  
Orbital Region ◽  
Ct And Mri

AbstractThis paper proposes a fully automatic method to segment the inner boundary of the bony orbit in two different image modalities: magnetic resonance imaging (MRI) and computed tomography (CT). The method, based on a deep learning architecture, uses two fully convolutional neural networks in series followed by a graph-search method to generate a boundary for the orbit. When compared to human performance for segmentation of both CT and MRI data, the proposed method achieves high Dice coefficients on both orbit and background, with scores of 0.813 and 0.975 in CT images and 0.930 and 0.995 in MRI images, showing a high degree of agreement with a manual segmentation by a human expert. Given the volumetric characteristics of these imaging modalities and the complexity and time-consuming nature of the segmentation of the orbital region in the human skull, it is often impractical to manually segment these images. Thus, the proposed method provides a valid clinical and research tool that performs similarly to the human observer.

scholarly journals Intracranial Hemorrhage Following Thrombolytic Use for Stroke Caused by Infective Endocarditis

2009 ◽  
Vol 12 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Parita Bhuva ◽  
Sheng-Han Kuo ◽  
J. Claude Hemphill ◽  
George A. Lopez
Keyword(s):  
Infective Endocarditis ◽  
Intracranial Hemorrhage

Pediatric Reversible Cerebral Vasoconstriction Syndrome: Two Unique Cases with a Review of all Reported Children

2021 ◽  
Author(s):  
Neelu Desai ◽  
Rahul Badheka ◽  
Nitin Shah ◽  
Vrajesh Udani
Keyword(s):  
Magnetic Resonance ◽  
Cerebral Arteries ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Neurological Deficits ◽  
Cerebral Vasoconstriction ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy ◽  
Mr Angiogram

AbstractReversible cerebral vasoconstriction syndrome (RCVS) has been well described in adults, but pediatric cases are yet under recognized. We describe two children with RCVS and review similar already published pediatric cases. The first patient was a 10-year-old girl who presented with severe headaches and seizures 3 days after blood transfusion. Brain magnetic resonance imaging (MRI) showed changes compatible with posterior reversible encephalopathy syndrome and subarachnoid hemorrhage. Magnetic resonance angiogram showed diffuse vasoconstriction of multiple cerebral arteries. The second patient was a 9-year-old boy who presented with severe thunderclap headaches. Brain MRI showed isolated intraventricular hemorrhage. Computed tomography/MR angiogram and digital subtraction angiogram were normal. A week later, he developed focal neurological deficits. Repeated MR angiogram showed diffuse vasospasm of multiple intracranial arteries. Both children recovered completely. A clinico-radiological review of previously reported childhood RCVS is provided.

scholarly journals Diagnosing RCVS Without the CV

2015 ◽  
Vol 6 (3) ◽  
pp. NP1-NP4 ◽  
Author(s):  
Nuri Jacoby ◽  
Ulrike Kaunzner ◽  
Marc Dinkin ◽  
Joseph Safdieh
Keyword(s):  
Magnetic Resonance ◽  
Resonance Imaging ◽  
Multiple Risk Factors ◽  
Mri Brain ◽  
Cerebral Vasoconstriction ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy ◽  
Occipital Lobes ◽  
The Brain

This is a case of a 52-year-old man with a past medical history of 2 episodes of coital thunderclap headaches as well as recent cocaine, marijuana, and pseudoephedrine use, who presented with sudden, sharp, posterior headache associated with photophobia and phonophobia. His initial magnetic resonance imaging (MRI) of the brain, magnetic resonance angiography (MRA) of the head, and magnetic resonance venography (MRV) of the head were all normal as well as a normal lumbar puncture. Given the multiple risk factors for reversible cerebral vasoconstriction syndrome (RCVS), the patient was treated for suspected RCVS, despite the normal imaging. Repeat MRI brain 3 days after hospital admission demonstrated confluent white matter T2 hyperintensities most prominent in the occipital lobes, typical of posterior reversible encephalopathy syndrome (PRES). Repeat MRA of the head 1 day after discharge and 4 days after the abnormal MRI brain showed multisegment narrowing of multiple arteries. This case demonstrates that RCVS may present with PRES on MRI brain and also exemplifies the need to treat suspected RCVS even if imaging is normal, as abnormalities in both the MRI and the MRA may be delayed.

scholarly journals High Mortality and Graft Loss After Infective Endocarditis in Kidney Transplant Recipients: A Case-Controlled Study From Two Centers

2021 ◽  
Author(s):  
Yanis Tamzali ◽  
Clément Danthu ◽  
Alexandra Aubry ◽  
Jean-François Faucher ◽  
Zhour El Ouafi ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Kidney Transplant ◽  
Graft Loss ◽  
Controlled Study ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Retrospective Case ◽  
Factors Associated ◽  
Streptococcus Gallolyticus ◽  
Duke Criteria

Purpose: Kidney Transplant Recipients (KTRs) tend to develop infections with characteristic epidemiology, presentation and outcome. While infective endocarditis (IE) is among such complications in KTRs, literature is scarce. We describe the presentation, epidemiology, and factors associated with IE in KTRs. Methods: We performed a retrospective case/control study which included patients from two centers. First episodes of definite or possible IE (Duke criteria), in adult KTRs from January 2007 to December 2018 were included, as well as two controls per case, and followed until December 31 2019. Clinical, biological, and microbiological data and the outcome were collected. Survival was studied using the Kaplan-Meier method. Finally, we searched for factors associated with the onset of IE in KTRs by the comparison of cases and controls. Results: Seventeen cases and 34 controls were included. IE was diagnosed after a mean delay of 78 months after KT, mostly on native valves of the left heart only. Pathogens of digestive origin were most frequently involved (six Enterococcus spp, three Streptococcus gallolyticus and one Escherichia coli), followed by Staphylococci (three cases of S. aureus and S. epidermidis each). Among the risk factors evaluated only age was significantly associated with the occurrence of IE in our study (63.8 years for cases vs. 55.6 years for controls, P=0.03) Patient and death-censored graft survival were greatly diminished five years after IE compared to controls being 50.3% vs. 80.6% (p<0.003) and 29.7% vs. 87.5% (p<0.002), respectively. Conclusion: IE in KTRs is a disease that carries significant risks both for the survival of the patient and the transplant.

scholarly journals Classification & Feature extraction of Brain tumor from MRI Images using Modified ANN Approach

2021 ◽  
Vol 9 (2) ◽  
pp. 10-15
Author(s):  
Harendra Singh ◽  
Roop Singh Solanki
Keyword(s):  
Feature Extraction ◽  
Brain Tumor ◽  
Computational Time ◽  
Discrete Wavelet ◽  
Classification Feature ◽  
Proposed Model ◽  
Magnetic Resonance Imaging Mri ◽  
Artificial Neural Network Ann ◽  
High Degree

In this research paper, a new modified approach is proposed for brain tumor classification as well as feature extraction from Magnetic Resonance Imaging (MRI) after pre-processing of the images. The discrete wavelet transformation (DWT) technique is used for feature extraction from MRI images and Artificial Neural Network (ANN) is used for the classification of the type of tumor according to extracted features. Mean, Standard deviation, Variance, Entropy, Skewness, Homogeneity, Contrast, Correlation are the main features used to classify the type of tumor. The proposed model can give a better result in comparison with other available techniques in less computational time as well as a high degree of accuracy. The training and testing accuracies of the proposed model are 100% and 98.20% with a 98.70 % degree of precision respectively.

Abstract WMP107: Neuroimaging Characteristics of Intracranial Hemorrhages and Microhemorrhages in Infective Endocarditis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sung-Min Cho ◽  
Robert Marquardt ◽  
Lucy Zhang ◽  
Prateek Thatikunta ◽  
Ken Uchino ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Intracranial Hemorrhage ◽  
Stroke Risk ◽  
Multivariate Logistic Regression Analysis ◽  
Cerebral Angiogram ◽  
Tertiary Referral Center ◽  
Imaging Characteristics ◽  
Median Volume ◽  
Mycotic Aneurysms ◽  
And Staphylococcus Aureus

Introduction: Intracranial hemorrhage (ICH) is common in infective endocarditis (IE). We explored the imaging characteristics, predictors, and clinical implications of ICHs including intraparenchymal hemorrhage (IPH), and subarachnoid hemorrhage (SAH) and, subdural hematoma (SDH). Methods: We reviewed records of 116 consecutive acute IE patients by Duke’s criteria with neurological consultation or admission to stroke neurology service in a single tertiary referral center from January 2015 to July 2016. ICHs were defined as IPH, SAH, or SDH seen on CT. Microhemorrhages were identified on susceptibility weighted imaging (SWI) on MRI. Patient’s radiographic characteristics and complications were collected. Results: Of 116 patients, 25 persons (21.6%, median age 58) had ICHs, 14 with IPHs, 7 with SAHs, 3 with both IPH and SAH, and 1 SDH. Of 17 (14.7%) IPHs (median NIH Stroke Scale 6 and median volume 38.6cc), 10 (8.6%) IPHs were symptomatic and 7 IPHs were silent. Eleven persons (65%) with IPH also had ischemic strokes. Mycotic aneurysms were identified only in 1 (4.8%) in 21 persons with ICH who underwent cerebral angiogram. MRIs identified 66 persons with microhemorrhages (56.9%, median age 58.5) among 85 who underwent MRI. Eighteen (72%) of 25 persons with ICHs had microhemorrhages in SWI. In multivariate logistic regression analysis, ICH was associated with the presence of >5 microhemorrhages (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.04-1.50) and staphylococcus aureus (OR: 1.25, 95% CI: 1.03-1.51). Ten persons (40%) with ICH died (7 with IPH and 4 with SAH) in the same hospitalization. Thirteen persons (52%) with ICH (median 21.4cc in 9 IPHs) underwent valve replacement at median of 13.5 days and 2 persons had new non-fatal strokes (1 IPH and 1 ischemic stroke). Conclusions: Intracranial macro- or micro-hemorrhages are seen in 73 (63%) persons with IE. The mortality of intracranial hemorrhage is high but the perioperative stroke risk appears low.

Abstract WMP35: The Characteristics of Infectious Intracranial Aneurysm and Indication of Cerebral Angiogram in Infective Endocarditis (IE)

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sung-Min Cho ◽  
Robert Marquardt ◽  
Lucy Zhang ◽  
Prateek Thatikunta ◽  
Ken Uchino ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Intracranial Aneurysm ◽  
Intracerebral Hemorrhage ◽  
Intracranial Hemorrhage ◽  
Cerebral Angiogram ◽  
Tertiary Referral Center ◽  
Valvular Surgery ◽  
Imaging Characteristics ◽  
Perioperative Complication ◽  
Glue Embolization

Introduction: Infectious intracranial aneurysm (IIA) can complicate infective endocarditis (IE). We aim to describe the characteristics of IIA and to assess indications for cerebral angiography. Methods: We reviewed IIAs among 116 consecutive active IE by Duke’s criteria with neurological consultation or admission to stroke neurology service in a single tertiary referral center from January 2015 to July 2016. Susceptibility weighted imaging (SWI) hemorrhage was defined as low signal on SWI in sulci or parenchyma that was not apparent on CT. Results: Of 116 patients, 74 persons (63.8%, mean age of 54) underwent digital subtraction angiography (DSA). IIAs were identified in 13 (17.6%). All of 13 IIAs were unruptured and only one IIA had unrelated intracranial hemorrhage on CT. None of the IIA was seen with CTA or MRA. Eleven (85%) IIAs had clinical strokes (10 ischemic strokes, 1 intracerebral hemorrhage, median NIH stroke scale 3), and 2 neurologically asymptomatic with abnormal MRI. Six of 9 IIAs had SWI hemorrhage in sulci or parenchyma (5 in sulci, 5 in parenchyma, and 1 in both) and all of the lesions were in the vicinity of IIA. Contrast MRI was performed in 7 IIAs, and 4 IIAs had enhancements, all of which were present near the location of IIAs. Ischemic stroke, intracranial hemorrhage, intravenous drug abuse, and type of valve were not associated with the presence of IIA. Of 13 IIAs, 3 remained on antibiotic alone, 5 had antibiotic with coil embolization, and, 5 had antibiotic with glue embolization. Ten patients with IIAs had valvular surgery, including one person with untreated IIA. Out of all patients with IIA, only one intracerebral hemorrhage occurred as perioperative complication unrelated to treated IIA. Conclusions: IIAs were found in approximately one fifth of IE persons who underwent DSA. Imaging characteristics such as SWI hemorrhage in sulci or parenchyma and contrast enhancement appear to correlate with the presence of IIA. DSA should be performed when they are present.

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