The treatment of patients with infective endocarditis-associated stroke (IEAS) differs greatly from that of other types of stroke, with thrombolytics contraindicated, so it is essential that emergency clinicians maintain a high index of suspicion for early identification of this highly morbid condition.
Our recent issue Emergency Department Management of Infective Endocarditis-Associated Stroke reviews the historical and physical examination factors that can provide clues to the etiology.
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Here are a few key points:
- When caring for patients with suspected stroke, endocarditis should always be considered. See Table 1 in the issue for key elements of history for both endocarditis and stroke.
- Neurologic complications are the most common extracardiac manifestations in infective endocarditis, occurring in 25% to 70% of cases.
- Risk factors for infective endocarditis include pre-existing valvular disease or valve replacement, healthcare utilization and instrumentation (25% of cases), immunocompromised states, hypercoagulable conditions, and IV drug use.
- Complications of infective endocarditis include intracerebral hemorrhage (ICH), stroke, transient ischemic attack, septic venous sinus thrombosis, meningitis, encephalitis, vertebral osteomyelitis, seizure, encephalopathy, and others; acute ischemic stroke is the most common.