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首页> 外文期刊>Medecine et maladies infectieuses >Neurological complications of infective endocarditis: New breakthroughs in diagnosis and management
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Neurological complications of infective endocarditis: New breakthroughs in diagnosis and management

机译：感染性心内膜炎的神经系统并发症：诊断和治疗的新突破

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Neurological complications are frequent in infective endocarditis (IE) and increase morbidity and mortality rates. A wide spectrum of neurological disorders may be observed, including 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 a hallmark of left-sided abnormalities of native or prosthetic valves. Ischemic lesions account for 40% to 50% of IE central nervous system complications. Systematic brain MRI may reveal cerebral abnormalities in up to 80% of patients, including cerebral embolism in 50%, mostly asymptomatic. Neurological complications affect both medical and surgical treatment and should be managed by an experimented multidisciplinary team including cardiologists, neurologists, intensive care specialists, and cardiac surgeons. Oral anticoagulant therapy given to patients presenting with cerebral ischemic lesions should be replaced by unfractionated heparin for at least 2 weeks, with a close monitoring of coagulation tests. Recently published data suggest that after an ischemic stroke, surgery indicated for heart failure, uncontrolled infection, abscess, or persisting high emboli risk should not be delayed, provided that the patient is not comatose or has no severe deficit. Surgery should be postponed for 2 to 3 weeks for patients with intracranial hemorrhage. Endovascular treatment is recommended for cerebral mycotic aneurysms, if there is no severe mass effect. Recent data suggests that neurological failure, which is associated with the location and extension of brain injury, is a major determinant for short-term prognosis.
机译：神经系统并发症在感染性心内膜炎（IE）中很常见，并且会增加发病率和死亡率。可以观察到广泛的神经系统疾病，包括中风或短暂性脑缺血发作，脑出血，真菌性动脉瘤，脑膜炎，脑脓肿或脑病。大多数并发症发生在IE的早期，是自然瓣膜或人工瓣膜左侧异常的标志。缺血性病变占IE中枢神经系统并发症的40％至50％。系统性脑MRI可以显示多达80％的患者的脑部异常情况，包括50％的脑栓塞，大部分无症状。神经系统并发症会影响药物和手术治疗，应由经过实验的多学科团队进行管理，包括心脏病专家，神经科医生，重症监护专家和心脏外科医师。对于患有脑缺血性病变的患者，应口服普通抗凝剂替代口服抗凝剂至少2周，并密切监测凝血试验。最近发表的数据表明，在缺血性中风后，如果患者没有昏迷或没有严重的赤字，就不应推迟针对心力衰竭，感染不受控制，脓肿或持续的高栓塞风险的手术。颅内出血患者应推迟手术2至3周。如果没有严重的质量效应，建议对脑真菌性动脉瘤进行血管内治疗。最新数据表明，与脑损伤的位置和范围有关的神经功能衰竭是短期预后的主要决定因素。

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