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When the heart rules the head: ischaemic stroke and intracerebral haemorrhage complicating infective endocarditis
  1. Estabrak Jiad1,
  2. Sumanjit K Gill1,2,
  3. Maria Krutikov1,
  4. David Turner1,
  5. Michael H Parkinson1,
  6. Carmel Curtis3,
  7. David J Werring1,2
  1. 1 Department of Neurology, National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
  2. 2 Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK
  3. 3 Department of Microbiology, University College Hospital, London, UK
  1. Correspondence to Prof David J Werring, Clinical Neurology, Stroke Research Centre, UCL Institute of Neurology, Box 6, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; d.werring{at}


Sir William Osler meticulously described the clinical manifestations of infective endocarditis in 1885, concluding that: ‘few diseases present greater difficulties in the way of diagnosis … which in many cases are practically insurmountable’. Even with modern investigation techniques, diagnosing infective endocarditis can be hugely challenging, yet is critically important in patients presenting with stroke (both cerebral infarction and intracranial haemorrhage), its commonest neurological complication. In ischaemic stroke, intravenous thrombolysis carries an unacceptably high risk of intracranial haemorrhage, while in intracerebral haemorrhage, mycotic aneurysms require urgent treatment to avoid rebleeding, and in all cases, prompt treatment with antibiotics and valve surgery may be life-saving. Here, we describe typical presentations of ischaemic stroke and intracerebral haemorrhage caused by infective endocarditis. We review the diagnostic challenges, the importance of rapid diagnosis, treatment options and controversies.

  • Stroke
  • Endocarditis
  • Infectious Diseases
  • Intracerebral haemorrhage

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