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.
Keywords: Cardiac surgery, cerebral abscess, endocarditis, neurological complications, neurosurgery, valve replacement.
Properties and Potency of Small Molecule Agents for Treatment of Mycobacterium Tuberculosis Infections of the Central Nervous System
Central Nervous System Agents in Medicinal Chemistry Synthesis of Imidazo[1,2-b]pyridazine Comprised Piperazine, Morpholine Derivatives as Potent Antimycobacterial Agents with In Vivo Locomotor Activity
Anti-Infective Agents Therapeutic Targeting of Leukocyte Trafficking Across the Blood-Brain Barrier
Inflammation & Allergy - Drug Targets (Discontinued) Research Progress in Live Attenuated Brucella Vaccine Development
Current Pharmaceutical Biotechnology The Blood-Brain Barrier: Targeting in the Pathogenesis of C. neoformans Meningitis and Drug Discovery
Anti-Infective Agents The Injured Cochlea as a Target for Inflammatory Processes, Initiation of Cell Death Pathways and Application of Related Otoprotective Strategies
Recent Patents on CNS Drug Discovery (Discontinued) The Neuroinflammatory Response in Plaques and Amyloid Angiopathy in Alzheimers Disease: Therapeutic Implications
Current Drug Targets - CNS & Neurological Disorders Hyaluronidases: A Therapeutic Enzyme
Protein & Peptide Letters Static Cerebral Blood Flow Autoregulation in Humans
Current Hypertension Reviews Adverse Reactions and Pathogen Safety of Intravenous Immunoglobulin
Current Drug Safety Advances in Neuroimaging for HIV-1 Associated Neurological Dysfunction: Clues to the Diagnosis, Pathogenesis and Therapeutic Monitoring
Current HIV Research When to Start Antiretroviral Therapy in HIV-Associated Tuberculosis
Current Respiratory Medicine Reviews Laboratory Techniques for Human Viral Encephalitis Diagnosis
Infectious Disorders - Drug Targets The Role of Bacterial DNA in Inflammatory and Allergic Disease
Recent Patents on Inflammation & Allergy Drug Discovery Recent Developments in Synthetic Oligosaccharide-Based Bacterial Vaccines
Current Topics in Medicinal Chemistry Anti-Inflammatory Adjuvant Agents in Bacterial Meningitis
Current Medicinal Chemistry - Anti-Inflammatory & Anti-Allergy Agents Drug Discovery in Enteroviral Infections
Infectious Disorders - Drug Targets Hyaluronidase Inhibitors: A Biological and Therapeutic Perspective
Current Medicinal Chemistry Oxidative Brain Damage by Peroxynitrite in Bacterial Meningitis: A Target for Adjunctive Therapy?
Current Medicinal Chemistry - Central Nervous System Agents Design of New Oxazaphosphorine Anticancer Drugs
Current Pharmaceutical Design