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Abstract Details

MRI brain findings in patients with Infective Endocarditis
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
214

Objective/Background:

The opioid epidemic has increased cases of IE related to intravenous drug use.  We sought to characterize MRI neuroimaging findings associated with infective endocarditis (IE) related to drug abuse.
NA

We includes patients diagnosed with stroke due to definite (per Duke’s criteria) IE related to drug abuse with MRI brain Diffusion weighted images (DWI) performed at our institution from January 2018 to 2020. Data was collected on demographics, CT brain, echocardiogram results, and discharge disposition.  MRI susceptibility weighted imaging (SWI) was evaluated for remote microhemorrhages or subarachnoid hemorrhage. Vascular imaging was reviewed for presence of large vessel occlusion (LVO).
We identified 40 patients with MRI imaging available and had stroke due to drug-related IE.  The mean age was 35.4 years (range, 20 to 49), 16 (40%) female, and 38 (95%) were white.  All patients had vegetations, multiple valves were affected in 15 (37.5%), mitral in 11 (27.5%), aortic in 9 (22.5%), and tricuspid in 5 (12.5%). CT brain showed hemorrhage in 17 (42.5%), and most (15) had ischemic infarcts as well. MRI DWI showed embolic acute infarcts in 28 (70%), single territory infarct in 7 (17.5%), and negative in 5 (12.5%).  Among the 33 MRI SWI, 20 (60.1%) were positive for remote hemorrhage.  On vascular imaging, mycotic aneurysms were seen in 8 (20%) and LVO in 8 (20%).  Nine (22.5%) had recurrent cerebrovascular events with interval development of new hemorrhage in 7 and infarcts in 2.  Inpatient mortality occurred in 15 (37.5%). Among survivors, 2 (5%) left AMA, and 23 (57.5%) were discharged to facilities.

Among patients with stroke due to IE related to drug abuse, MRI DWI showed embolic pattern infarcts in the majority of patients (70%) and remote hemorrhages were common on SWI (60%).  Patients with cerebrovascular complications had a significant rate of in-patient mortality at 37.5%.
Authors/Disclosures
Lisa M. Moore, MD
PRESENTER 		Dr. Moore has nothing to disclose.
Lindsay A. Bliss, DO (Bronson Hospital) Dr. Bliss has nothing to disclose.
Vivien H. Lee, MD, FÂ鶹´«Ã½Ó³»­ (OSU Comprehensive Neurovascular Center) Dr. Lee has nothing to disclose.