Clinical characteristics of infective endocarditis in elderly patients with cerebral infarction as the initial presentation / 中华老年医学杂志

ABSTRACT

Objective:To investigate the clinical characteristics, diagnosis, treatment and prognosis of infective endocarditis(IE)in elderly patients with cerebral infarction as the first presentation.Methods:The clinical data of 5 elderly infective endocarditis patients with cerebral infarction as the first presentation diagnosed and treated in Beijing Shijitan Hospital, Capital Medical University from October 2010 to December 2021 were retrospectively analyzed, and national and international reports from January 1998 to December 2021 on IE in the elderly with cerebral infarction as the first presentation were collected.The clinical characteristics, diagnosis and prognosis were analyzed and summarized.Results:A total of 18 IE cases with cerebral infarction as the first presentation were reviewed, including 5 cases from our hospital.The male to female ratio was 5∶1, and the median age was 70.5 years.IE was diagnosed several hours to 4 months after the onset of cerebral infarction.All the patients had speech impairment symptoms and most of them exhibited hemiparesis.The National Institute of Health Stroke Scale(NIHSS)scores ranged between 2-35.All 18 patients underwent blood culture, and streptococci were the most common pathogens.Most of the lesions were located in the blood supply area of the middle cerebral artery or the junction between the middle cerebral artery and the posterior cerebral artery.Echocardiography showed that mitral valve vegetations were the dominant features, followed by aortic valve vegetations.All 18 patients received antibiotic treatment, 2 underwent valve replacement and removal of vegetations, and 11 underwent intravenous thrombolysis or mechanical thrombectomy.50.0% of patients(9 cases)had a good prognosis and one third(6 cases)died.Conclusions:Cerebral infarction is the first presentation in some elderly IE patients, and misdiagnoses are common, but half of patients can have a good prognosis after timely anti-infection and surgical treatment.