Neurologic complications in infective endocarditis: Data from the Iranian registry of infective endocarditis

Introduction: Neurological complications (NCs) in patients with infective endocarditis (IE) are life-threatening and can be avoided or managed properly if diagnosed early. We aimed to determine the incidence and risk factors of NC in a large group of patients with IE. Methods: Patients with definite or possible IE diagnosed based on the Duke criteria were included from 2006 to 2019. Data were derived from the single-center Iranian Registry of Infective Endocarditis (IRIE) retrospectively. NCs may be diagnosed on admission or during hospitalization till discharge. NCs were classified into the following categories: embolic cerebral events, hemorrhagic stroke, brain abscess, and mycotic aneurysms. Findings: In this study, 456 (65.9%) patients had definite and 236 (34.1%) had possible IE. Moreover, 16.5% of the patients had a history of stroke or transient ischemic attack (TIA), and 57.2% of the patients had a vegetation size>1 cm. The most common predisposing factors of IE were congenital heart disease (33.9%) and prosthetic valve (25.5%), respectively. The most frequently isolated microorganism in the blood cultures was Staphylococcus aureus (11.8%), followed by Streptococcus viridans (9.3%). The most common NCs were cerebral embolic events (91 patients, 19%) and cerebral mycotic aneurysms (31 patients). The most frequently used mechanical valve in patients with NCs is the mitral valve, followed by the aortic valve. Fifteen patients (16.1%) with NCs had in-hospital mortality. Conclusion: Our findings reveal that NCs are common, so it is highly recommended to perform a neurological consultation in all left-sided endocarditis cases and initiate antibiotic therapy, despite not knowing the exact microorganism on the first day.