ABSTRACT

INTRODUCTION. Infectious endocarditis is characterized by high mortality and diverse clinical manifestations. The lesions of the nervous system in infectious endocarditis occurs in 60-80% of cases and can range from asymptomatic to severe presentations. The defeat of the nervous system in IE is often caused by ischemic strokes and intracerebral hemorrhages.

CASE PRESENTATION. We present the young patient with recurrent infectious endocarditis, whose debut was marked by fever and severe cerebral symptoms. Сomputer and magnetic resonance imaging scans of the brain revealed intracerebral hemorrhage in the left occipital lobe and multiple focal lesions suggestive of an intracranial infection. It became necessary to conduct  surgical treatment of infectious endocarditis due to appearance of symptoms and rapid progression of heart failure despite appropriate antibiotic therapy. The intracerebral hemorrhage has become a major obstacle to surgical treatment of infectious endocarditis. The article shows how the solutions adopted by the multidisciplinary team allowed to solve this problem.

KEYWORDS: infective endocarditis, mycotic aneurysm, intracranial hemorrhage, cardiac surgical procedures, central nervous system

For citation: Vasileva O.V., Nazarova M.N., Kiyakbaev G.K., Piskun A.V., Krichevskiy L.A.,  Sychev I.N., Rachina S.А., Ananicheva N.A., Tarasenko S.N., Mirzakhamidova S.S., Titova E.Yu., Karpova O.Yu. Polymorphic Brain Damage as a Leading Manifestation of the Debut of Infective Endocarditis: Case Report. Comorbidity Neurology. 2025; 2 (2): 88-96. https://doi.org/10.62505/3034-185x-2025-2-2-88-96

*For correspondence: Svetlana А. Rachina, Dr.Sci. (Med.), Professor of the Russian Academy of Sciences, Head of the Department of Hospital Therapy No. 2 of the Institute of Clinical Medicine named after N.V. Sklifosovsky, I.M. Sechenov First Moscow State Medical University, Moscow, Russia,  e-mail: rachina_s_a@staff.sechenov.ru

REFERENCES

1.Momtazmanesh S., Saeedi Moghaddam S., Malakan Rad E., et al. Global, regional, and national burden and quality of care index of endocarditis: the global burden of disease study 1990–2019. European Journal of Preventive Cardiology. 2022; 29 (8): 1287-1297. https://doi.org/10.1093/eurjpc/zwab211

2. Chen H., Zhan Y., Zhang K., et al. The Global, Regional, and National Burden and Trends of Infective Endocarditis From 1990 to 2019: Results From the Global Burden of Disease Study 2019. Front Med (Lausanne) 2022; 9: 774224. https://doi.org/10.3389/fmed.2022.774224

3.Moiseev V.S., Kobalava Z.D., Pisaryuk A.S. et al. Infective Endocarditis in Moscow General Hospital: Clinical Characteristics and Outcomes (Single-Center 7 Years’ Experience). Kardiologiia. 2018; 58 (12): 66-75. https://doi.org/10.18087/cardio.2018.12.10192 (In Russ.)

4.Федеральная служба государственной статистики. Дата доступа 6 марта 2025. https://rosstat.gov.ru/ 

5.Symptomatic and Asymptomatic Neurological Complications of Infective Endocarditis: Impact on Surgical Management and Prognosis. PLOS One. Accessed March 3, 2025. https://doi.org/10.1371/journal.pone.0158522

6.Iung B., Doco-Lecompte T., Chocron S., et al. Cardiac surgery during the acute phase of infective endocarditis: discrepancies between European Society of Cardiology guidelines and practices. European Heart Journal. 37 (10): 840-848. https://doi.org/10.1093/eurheartj/ehv650

7.Sotero F. D., Rosário M., Fonseca A. C., et al. Neurological Complications of Infective Endocarditis. Curr Neurol Neurosci Rep. 2019;19 (5): 23. https://doi.org/10.1007/s11910-019-0935-x

8.Sakovets T.G., Khuzina G.R. Neurological complications of infective endocarditis: clinic, diagnosis, treatment. Practical Medicine. 2018; 16 (10): 25-29. https://doi.org./10.32000/2072-1757-2018-10-25-29 (In Russ.)

9.Delgado V., Ajmone Marsan N., Waha S., et al. 2023 ESC Guidelines for the management of endocarditis: Developed by the task force on the management of endocarditis of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Nuclear Medicine (EANM). European Heart Journal. 2023; 44 (39): 3948-4042. https://doi.org/10.1093/eurheartj/ehad193

10.Ruttmann E., Willeit J., Ulmer H., et al. Neurological outcome of septic cardioembolic stroke after infective endocarditis. Stroke. 2006; 37 (8): 2094-2099. https://doi.org/10.1161/01.STR.0000229894.28591.3f

11.Sotero F.D., Rosário M., Fonseca A.C., et al. Neurological Complications of Infective Endocarditis. Current Neurology and Neuroscience Reports. 2019; 19 (23). https://doi.org/10.1007/s11910-019-0935-x

12.Nitsch L., Shirvani Samani O., Silaschi M., et al. Infective endocarditis and stroke: when does it bleed? A single center retrospective study. Neurological Research and Practice. 2023; 5 (1):13. https://doi.org/10.1186/s42466-023-00239-7

13.García-Cabrera E., Fernández-Hidalgo N., Almirante B., et al. Neurological Complications of Infective Endocarditis. Circulation. 2013; 127 (23): 2272-2284. https://doi.org/10.1161/CIRCULATIONAHA.112.000813

14.Behrouz R. Preoperative Cerebrovascular Evaluation in Patients With Infective Endocarditis. Clinical Cardiology. 2015; 38 (7): 439-442. https://doi.org/10.1002/clc.22400

15.Krylov V.V., Dashyan V.G., Mukha A.M. Surgical Treatment of Ruptured Cavernous Brain Malformations. Nevrologicheskiy Zhurnal (Neurological Journal). 2016; 21 (1): 24–29. https://doi.org./10.18821/1560-9545-2016-21-1-24-29 (In Russ.)

16.Schrag M., Kirshner H. Management of Intracerebral Hemorrhage: JACC Focus Seminar. Journal of the American College of Cardiology. 2020; 75 (15): 1819-1831. https://doi.org/10.1016/j.jacc.2019.10.066

17. Demin A.A., Kobalava Zh.D., Skopin I.I. et al. Infectious endocarditis and infection of intracardiac devices in adults. Clinical guidelines 2021. Russian Journal of Cardiology. 2022;27 (10): 5233. https://doi.org/10.15829/1560-4071-2022-5233 (In Russ.)

18.Vahanian A., Beyersdorf F., Praz F., et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal. 2022; 43 (7): 561-632. https://doi.org/10.1093/eurheartj/ehab395

ADDITIONAL INFORMATION

Olga V. Vasileva, student of the Institute of Clinical Medicine named after N.V. Sklifosovsky, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. E-mail: ioluca61@gmail.com. ORCID: https://orcid.org/0000-0003-0726-5020

Mariya N. Nazarova, student of the Institute of Clinical Medicine named after N.V. Sklifosovsky, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. E-mail: nazarova.mariya30@gmail.com. ORCID: https://orcid.org/0009-0002-3772-8321

Gayrat K. Kiyakbaev, Dr. Sci. (Med.), Professor, Professor of the Department of Hospital Therapy No. 2 of the Institute of Clinical Medicine named after N.V. Sklifosovsky, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. E-mail: kayakbaev_g_k@staff.sechenov.ru. ORCID: https://orcid.org/0000-0002-8882-6143

Alexandr V. Piskun, Ph.D. Sci. (Med.), Head of Cardiac Surgery Department, S.S. Yudin City Clinical Hospital, Moscow, Russia. ORCID: https://orcid.org/0000-0001-9297-4061

Lev A. Krichevskiy, Dr. Sci. (Med.), Head of Anesthesiology and Intensive Care Department No. 2, S.S. Yudin City Clinical Hospital, Moscow, Russia; Head of Anesthesiology and Intensive Care Department, Russian Medical Academy of Continuing Professional Education, Moscow, Russia. E-mail: levkrich72@gmail.com. ORCID: https://orcid.org/0000-0001-8886-7175

Igor N. Sychev, Ph.D. Sci. (Med.), Associate Professor of the Department of Clinical Pharmacology and Therapeutics, Russian Medical Academy of Continuing Professional Education, Moscow, Russia; Head of the Clinical Pharmacology Department, S.S. Yudin City Clinical Hospital, Moscow, Russia. E-mail: sychevigor@mail.ru. ORCID: https://orcid.org/0000-0002-2970-3442

Svetlana А. Rachina, Dr. Sci. (Med.), Professor of the Russian Academy of Sciences, Head of the Department of Hospital Therapy No. 2 of the Institute of Clinical Medicine named after N.V. Sklifosovsky, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. E-mail: rachina_s_a@staff.sechenov.ru. ORCID: https://orcid.org/0000-0002-3329-7846

Nataliia A. Ananicheva, Head of the Regional Vascular Center, S.S. Yudin City Clinical Hospital, Moscow, Russia. E-mail: nn.ananicheva@mail.ru. ORCID: https://orcid.org/0000-0002-3142-619Х

Svetlana N. Tarasenko, Head of Cardiology Department No.4, S.S. Yudin City Clinical Hospital, Moscow, Russia. E-mail: dr.tarasenkos@gmail.com. ORCID: https://orcid.org/0000-0002-8099-1494

Svetlana S. Mirzakhamidova, Ph.D. Sci. (Med.), Deputy Chief Physician at the Medical Unit, S.S. Yudin City Clinical Hospital, Moscow, Russia. E-mail: rimatevs@mail.ru. ORCID: https://orcid.org/0000-0002-5807-5027

Elena Yu. Titova, Head of the Department of Neurology No.1, S.S. Yudin City Clinical Hospital, Moscow, Russia. E-mail: Elena.titova11.06@mail.ru

Olga Yu. Karpova, Ph.D. Sci. (Med.), Associate Professor of the Department of Hospital Therapy No. 2 of the Institute of Clinical Medicine named after N.V. Sklifosovsky, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. E-mail: karpova_o_yu_1@staff.sechenov.ru, ORCID: https://orcid.org/0000-0003-2912-6793

Author contributions. All authors confirm that their authorship complies with the international ICMJE criteria (all authors made a significant contribution to the development of the concept, the conduct of the study and the preparation of the article, read and approved the final version before publication). Special contributions: Rachina S.А. – supervision, methodology, validation, data curation, formal analysis, writing – review & editing; Vasileva O.V., Nazarova M.N. – formal analysis, writing – original draft; Kiyakbaev G.K. – validation, formal analysis, writing – review & editing; Krichevskiy L.A., Sychev I.N., Ananicheva N.A., Tarasenko S.N., Mirzakhamidova S.S., Titova E.Yu. – investigation, data curation, resources; Karpova O.Yu. – formal analysis, writing – original draft.

Funding. This study was not supported by any external sources of funding.

Disclosure. The authors declare no apparent or potential conflicts of interest related to the publication of this article.

Informed consent for publication. Patient signed informed consent. 

The content is available under the Creative Commons Attribution 4.0 License.

©2025. Olga V. Vasileva, Mariya N. Nazarova, Gayrat K. Kiyakbaev et al.