A Puzzling Case of Cryptogenic Stroke.
Aged
Angiography, Digital Subtraction
Anti-Bacterial Agents
/ therapeutic use
Biopsy
Brain Ischemia
/ diagnostic imaging
Cerebral Angiography
/ methods
Computed Tomography Angiography
Endocarditis, Bacterial
/ complications
Enterococcus faecalis
/ isolation & purification
Gram-Positive Bacterial Infections
/ complications
Humans
Intracranial Embolism
/ diagnostic imaging
Male
Stroke
/ diagnostic imaging
Thrombectomy
Thrombolytic Therapy
Treatment Outcome
Stroke
clot aspiration
infective endocarditis
mechanical thrombectomy
thrombolysis
Journal
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
ISSN: 1532-8511
Titre abrégé: J Stroke Cerebrovasc Dis
Pays: United States
ID NLM: 9111633
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
received:
10
09
2018
revised:
29
12
2018
accepted:
01
01
2019
pubmed:
22
1
2019
medline:
10
4
2019
entrez:
22
1
2019
Statut:
ppublish
Résumé
Stroke is a common neurological complication of infective endocarditis (IE) and it is associated with increased morbidity and mortality but infective endocarditis in acute stroke setting is hard to discover. A 75-year-old man referred to hospital for the onset of left hemiparesis and dysarthria. His past medical history included hypertension. He had 3 months history of fatigue, fever, and weight loss. Neurological examination revealed left hemiparesis and dysarthria. Brain CT and CT angiography revealed a right M1 segment occlusion. Thrombolysis was delivered followed by mechanical thrombectomy by clot aspiration and recanalization was achieved. Anatomopathological analysis of the clot showed necrotic material and bacterial colonies consistent with septic emboli. The day after he developed fever and brain CT revealed a right parieto-occipital intraparenchymal and subarachnoid hemorrhage. Blood cultures demonstrated growth of Enterococcus faecalis. Treatment with vancomycin and ampicillin was started. Management of acute ischemic stroke related to IE is difficult. The great clinical challenge for the physician is recognizing the signs suggestive of IE in the acute stroke setting. Anatomo-pathological and bacteriological analysis of the clot in patients eligible to mechanical thrombectomy can provide the remarkable advantage to analyse directly the extracted material, allowing an early diagnosis and appropriate antibiotic therapies and treatments.
Sections du résumé
BACKGROUND
BACKGROUND
Stroke is a common neurological complication of infective endocarditis (IE) and it is associated with increased morbidity and mortality but infective endocarditis in acute stroke setting is hard to discover.
MATERIAL AND METHODS
METHODS
A 75-year-old man referred to hospital for the onset of left hemiparesis and dysarthria. His past medical history included hypertension. He had 3 months history of fatigue, fever, and weight loss. Neurological examination revealed left hemiparesis and dysarthria.
FINDINGS
RESULTS
Brain CT and CT angiography revealed a right M1 segment occlusion. Thrombolysis was delivered followed by mechanical thrombectomy by clot aspiration and recanalization was achieved. Anatomopathological analysis of the clot showed necrotic material and bacterial colonies consistent with septic emboli. The day after he developed fever and brain CT revealed a right parieto-occipital intraparenchymal and subarachnoid hemorrhage. Blood cultures demonstrated growth of Enterococcus faecalis. Treatment with vancomycin and ampicillin was started.
CONCLUSION
CONCLUSIONS
Management of acute ischemic stroke related to IE is difficult. The great clinical challenge for the physician is recognizing the signs suggestive of IE in the acute stroke setting. Anatomo-pathological and bacteriological analysis of the clot in patients eligible to mechanical thrombectomy can provide the remarkable advantage to analyse directly the extracted material, allowing an early diagnosis and appropriate antibiotic therapies and treatments.
Identifiants
pubmed: 30661972
pii: S1052-3057(19)30001-1
doi: 10.1016/j.jstrokecerebrovasdis.2019.01.001
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e33-e35Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.