Spectrum of neurological involvement in adult patients with bacterial endocarditis

Objective: To describe the spectrum of neurological involvement, and document in-hospital mortality in adult patients with bacterial endocarditis. Design: Descriptive, non-interventional. Place and Duration of Study: Department of Gastroenterology, The Aga Khan University Hospital, Karachi from November 1999 to October 2002. Patients and Methods: Patients were enrolled from the emergency and outpatient departments, using purposive, nonprobability sampling, provided they fulfilled pre-defined inclusion and exclusion criteria. Case records of patients admitted to hospital with a diagnosis of bacterial endocarditis were prospectively analyzed. Data was entered and analyzed on SPSS 11. Frequency, Mean, Mode and Percentage were calculated. Results: Neurological complications were observed in 14 out of 40 patients (35%). The most frequent complication was embolic infarction (33%), followed by intra-cranial hemorrhage (22 %). Seizures, encephalopathy, abscess and meningitis were all observed in decreasing order of frequency. Out of a total of 14 patients who suffered neurological complications, 06 died (42 %). Conclusion: The nervous system is frequently involved in patients with bacterial endocarditis. The nature of neurological involvement can vary from a fatal embolic infarction to infective complications, such as cerebral abscess or meningitis, to mild encephalopathy. The most frequently noted complication was embolic infarction. In-hospital mortality is significantly high in patients who suffer neurological complications.