Management of Infective Endocarditis with Neurological Complication

Abstract Neurological complications in patients with infective endocarditis are frequent and mortality is higher in those with neurological complications than in those without. The spectrum of neurological complications includes cerebral infarction, intracranial hemorrhage, intracranial infectious aneurysm, transient ischemic attack (TIA), meningitis, encephalopathy and brain abscess. The appropriate timing of valve surgery following a cerebrovascular event remains controversial because cardiopulmonary bypass may exacerbate neurological deficits. Previous studies suggest delaying valve surgery for 2 to 4 weeks following embolic stroke and at least 4 weeks following hemorrhagic stroke however, urgent valve surgery may be needed depending on the hemodynamic state of the patient. In the event of intracranial infectious aneurysm, therapeutic management is not perfectly standardized. We retrospectively reviewed the surgical results of infective endocarditis patients with neurological complications. Current trends in surgical timing and therapeutic decision-making are discussed.