Title:Drainage of Cerebral Abscesses Prior to Valve Replacement in Stable Patients with Acute Left-Sided Infective Endocarditis
Volume: 14
Issue: 4
Author(s): Adrian Molnar, Ruxandra Beyer, Stefan Florian, Dafin F. Muresanu, Catalin Trifan, Ioan Muresan, Diana Sacui, Traian Scridon and Radu N. Balanescu
Affiliation:
Keywords:
Cardiac surgery, cerebral abscess, endocarditis, neurological complications, neurosurgery, valve replacement.
Abstract: Despite the medical and surgical advancements in the treatment of patients with acute infective endocarditis
(IE), neurologic complications remain problematic. They can arise through various mechanisms consisting of stroke or
transient ischemic attack, cerebral hemorrhage, mycotic aneurysm, meningitis, cerebral abscess, or encephalopathy. Most
complications occur early during the course of IE and are characteristic to left-sided pathology of native or prosthetic
valves. We present a case of a 46 year old male patient who presented to our clinic with mitral valve IE caused by
coagulase negative staphylococcus. Although under correct antibiotic treatment, he continued to be feverish and started to
present unspecific neurological symptoms (amnesia, confusion, asthenia and general malaise). The cerebral magnetic
resonance imaging (MRI) revealed multiple cerebral abscesses. Because the patient was hemodynamically stable we
decided to address the cerebral abscess first and the cardiac lesion second. The patient made a full recovery after
undergoing antibiotic treatment and surgical procedures of drainage of the cerebral abscess and mitral valve replacement.
After reviewing the literature regarding the management of patients with IE and cerebral complications and based on this
particular case, we conclude that in select cases of stable patients with cerebral abscess and IE, the neurological lesion
should always be addressed first and cardiac surgery should be performed second.
