Neurologic Manifestations of Bacterial Endocarditis

Twenty-nine percent of patients (110 of 385) with bacterial endocarditis had neurologic involvement. In 60% (65 of 110 patients) the neurologic finding was either the chief complaint or one of the major presenting symptoms. Cerebrovascular lesions accounted for 50% (55 of 110) of the cases, and transient ischemic symptoms preceded the major stroke in 15 of the 55 (27%). Other major neurologic syndromes included toxic encephalopathy, meningitis, organic headache, mononeuritis, convulsions, and visual impairment. Occasionally, the initial diagnosis was not bacterial endocarditis but a primary neurologic illness or some other systemic disease. The mortality rate of 50% (55 of 110 patients) was 1.6 times greater than that expected in a general series of patients with endocarditis.