Stroke in patients with endocarditis is a unique, highly morbid condition requiring a high index of suspicion for diagnosis. This issue reviews the historical and physical examination factors that can provide clues to the etiology. The workup of these patients, involving both infection-focused and stroke-focused laboratory testing and neuroimaging, is discussed. The mainstay of treatment is empiric antibiotics, as thrombolytics are contraindicated. Recent evidence regarding the use of mechanical thrombectomy in large-vessel occlusion strokes is discussed, as well as surgical options and consultation strategies with stroke, neurocritical care, infectious disease, and neurosurgery teams.
How would you manage these patients? Subscribe for evidence-based best practices and to discover the outcomes.
Subscribe to access the complete flowchart to guide your clinical decision making.
Subscribe for full access to all Tables and Figures.
Buy this issue and
Following are the most informative references cited in this paper, as determined by the authors.
10. * Garcia-Cabrera E, Fernandez-Hidalgo N, Almirante B, et al. Neurological complications of infective endocarditis: risk factors, outcome, and impact of cardiac surgery: a multicenter observational study. Circulation. 2013;127(23):2272-2284. (Retrospective analysis; 1345 cases) DOI: 10.1161/CIRCULATIONAHA.112.000813
18. * Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications. Circulation. 2015;132(15):1435-1486. (Review, guideline) DOI: 10.1161/CIR.0000000000000296
49. * Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke. Stroke. 2019;50(12). (Guidelines) DOI: 10.1161/STR.0000000000000211
59. * Marquardt RJ, Cho SM, Thatikunta P, et al. Acute ischemic stroke therapy in infective endocarditis: case series and systematic review. J Stroke Cerebrovasc Dis. 2019;28(8):2207-2212. (Retrospective study; 8 patients; systematic review, 24 publications, 32 participants) DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.039
74. * Bettencourt S, Ferro JM. Acute ischemic stroke treatment in infective endocarditis: systematic review. J Stroke Cerebrovasc Dis. 2020;29(4):104598. (Systematic review; 37 articles, 52 patients) DOI: 10.1016/j.jstrokecerebrovasdis.2019.104598
87. * Ruttmann E, Willeit J, Ulmer H, et al. Neurological outcome of septic cardioembolic stroke after infective endocarditis. Stroke. 2006;37(8):2094-2099. (Epidemiological study; 65 patients) DOI: 10.1161/01.STR.0000229894.28591.3f
Subscribe to get the full list of 96 references and see how the authors distilled all of the evidence into a concise, clinically relevant, practical resource.
Keywords: endocarditis, ischemic stroke, marantic, ICH, septic embolic stroke, IV drug use, thrombolytic, thrombectomy, hemorrhage, infectious intracranial aneurysm, antibiotics
Lauren Gillespie, MD; Natalie Kreitzer, MD
Jeffrey Miller, MD; Vasisht Srinivasan, MD
March 1, 2023
March 1, 2026   CME Information
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Stroke CME credits.
Price: $59
+4 Credits!
Lauren Gillespie, MD; Natalie Kreitzer, MD
Jeffrey Miller, MD; Vasisht Srinivasan, MD
March 1, 2023
March 1, 2026
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Stroke CME credits.
Current Topics in Acute Stroke Care - Stroke EXTRA Supplement (Stroke CME)
Pediatric Stroke: Diagnosis and Management in the Emergency Department - Stroke EXTRA Supplement
Pediatric Stroke: Diagnosis and Management in the Emergency Department