Key result
Multifocal embolic strokes may be the first clinical manifestation of infective endocarditis and may necessitate repeat transesophageal echocardiogram and blood cultures even if initial evaluation is negative.
Why the study?
Early detection of infective endocarditis is challenging because initial echocardiograms can be negative and patients may lack systemic signs of infection.
Case Report (n=1)
No
Infective endocarditis should remain on the differential for embolic strokes in patients with prosthetic valves, even if initial TEE is negative and systemic signs of infection are absent.
Negative TTE/TEE does not exclude IE in embolic stroke; leaves open role of clinical suspicion and advanced imaging.
Infective endocarditis (IE) is a common cause of embolic strokes. Early diagnosis and treatment are essential to decrease the risk of ischemic stroke and ensure appropriate treatment, particularly given the higher risk of hemorrhagic complications. Treatment is also essential to prevent other complications such as heart failure, perivalvular abscesses, or intracranial abscesses. Transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) may not show endocardial involvement in the early stages of IE and, rarely, some patients may lack systemic signs of infection, making the early detection of IE challenging. Multifocal ischemic strokes may be the initial manifestation of IE and warrant further workup directed at IE even if initial echocardiogram findings are negative. A high index of clinical suspicion and thorough history are of utmost importance.
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Karazanashvili et al. (2022) conducted a case report in Prosthetic Valve Endocarditis (n=1). Intravenous antibiotics and surgical valve repair was evaluated. Multifocal embolic strokes may be the first clinical manifestation of infective endocarditis and may necessitate repeat transesophageal echocardiogram and blood cultures even if initial evaluation is negative.
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