PT  - JOURNAL ARTICLE
AU  - Estabrak Jiad
AU  - Sumanjit K Gill
AU  - Maria Krutikov
AU  - David Turner
AU  - Michael H Parkinson
AU  - Carmel Curtis
AU  - David J Werring
TI  - When the heart rules the head: ischaemic stroke and intracerebral haemorrhage complicating infective endocarditis
AID  - 10.1136/practneurol-2016-001469
DP  - 2017 Feb 01
TA  - Practical Neurology
PG  - 28--34
VI  - 17
IP  - 1
4099  - http://pn.bmj.com/content/17/1/28.short
4100  - http://pn.bmj.com/content/17/1/28.full
SO  - Pract Neurol2017 Feb 01; 17
AB  - 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.