Is infectious endocarditis a rare cause of stroke in a young patient?

Introduction: Infectious endocarditis has an incidence of 3 to 9 in 100,000 people and appears in more than 50% of cases in patients with valvular heart disease, patients with prosthetic heart valves and patients with untreated congenital cardiomyopathy. Despite multiple diagnostic and treatment techniques, infectious endocarditis is still a disease with a high level of morbidity and mortality. Methods: We present the case of a 37 years old patient with a history of aortic valve endocarditis in 2008, treated with antibiotics. The patient, afterwards presenting 4 ischemic strokes, was admitted with aggravated dyspnea in the previous 2 weeks. Clinical and paraclinical investigations confirm the existence of a severe aortic valve disease (severe aortic insufficiency aft er endocarditis with small and mobile vegetations attached on the valve) on a pacient with significant atherosclerotic lesions at the carotid arteries (bilateral occlusion of the internal carotid). The patient was then addressed to a cardiothoracic surgeon who performed bilateral carotid endarterectomy and inserted an aortic valve prosthesis, with favorable outcome. Results: Stroke is one of the major complications that can appear in a patient with a history of bacterial endocarditis, with an incidence of 20% of all complications. Ischemic stroke is more common than hemorrhagic stroke in these patients. The association of atherosclerotic carotid disease increases the risk of neurologic complications. Conclusions: The risk of neurologic complications in patients with infectious endocarditis is relatively small. However, the association of severe atherosclerotic carotid disease in a young patient is rare.

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