Drainage of Cerebral Abscesses Prior to Valve Replacement in Stable Patients with Acute Left-Sided Infective Endocarditis
| Autor: | Catalin Trifan, Stefan Ioan Florian, Dafin F. Muresanu, Radu N. Balanescu, Ruxandra Ștefana Beyer, Ioan Muresan, Diana Sacui, Adrian Molnar, Traian Scridon |
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| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Brain Abscess Valve replacement Mitral valve medicine Humans Abscess Stroke Pharmacology Heart Valve Prosthesis Implantation business.industry General Neuroscience Mitral valve replacement Endocarditis Bacterial Mycotic aneurysm Staphylococcal Infections medicine.disease Cardiac surgery Surgery medicine.anatomical_structure Anesthesia Drainage business Meningitis |
| Zdroj: | ResearcherID |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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