Abstract
Infective endocarditis (IE) presents various complications. Here, we report two cases of rapidly progressing neurological symptoms due to IE complications. Case 1: A 57-year-old woman was hospitalized with toxic epidermal necrolysis. On hospital day 38, brain computed tomography (CT) revealed hemorrhage in the left occipital lobe. Following hematoma removal and decompressive craniectomy, repeated echocardiography showed no abnormal findings. On postoperative day (POD) 24, CT revealed a new hemorrhage and cerebral aneurysm in the peripheral left middle cerebral artery; however, cerebral angiography 7 days later showed that the aneurysm had disappeared. Transesophageal echocardiography on POD 26 showed vegetation on the mitral valve. Following mitral valve replacement, she was transferred to a rehabilitation hospital. Case 2: A 50-year-old woman was hospitalized with disturbance of consciousness and left hemiparesis. Magnetic resonance imaging showed cerebral infarction with right middle cerebral artery occlusion. Echocardiography showed vegetation on the aortic valve and replacement was performed. CT showed brain swelling with a midline shift on POD 1 and she underwent decompressive craniectomy, after which she was transferred to a rehabilitation hospital. To achieve a good prognosis it is necessary to consider the timing of surgery and intensive care strategies taking into account the complications of IE.
