Neurological Complications of Infective Endocarditis

This chapter provide recent insights in mechanisms and management of neurologic complications in patients with left-sided infective endocarditis (IE). Neurologic complications contribute to a poor prognosis, increasing mortality and morbidity from disabling sequelae.Cerebral lesions are thought to involve synergistic pathophysiological mechanisms including thromboembolism, sepsis, meningitis and small-vessel cerebral vasculitis.Symptomatic cerebral ischemic or hemorrhagic events occur in 20–55% of IE patients, but asymptomatic cerebral events are actually detected in the majority (60–80%) of patients undergoing brain MRI. The latter represents a major tool in the management of patients, and can impact therapeutic decisions and prognosis, especially when cardiac surgery is indicated. In patients presenting with neurologic complications, notably ischemic events, recent studies suggest that surgery could be safely performed earlier than previously thought. Altered mental status at IE onset, which is associated with brain injury, constitutes an additional major determinant of short-term outcome.Other important issues include the appropriate use of anti-infective and antithrombotic agents, and endovascular treatment for mycotic aneurysms, for which uncertainties remain.Neurologic complications in IE patients remain a serious issue, whose management and diagnosis are challenging, requiring an experienced multidisciplinary team.