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Encephalopathy with Staphylococcal Endocarditis: Multiple Neuropathological Findings

Published online by Cambridge University Press:  02 December 2014

S.G. Weeks ,
C.J. Doig ,
C. Silva ,
R.N. Auer ,
C. Power  and
M.J. Gill
S.G. Weeks
Affiliation:
Department of Medicine, University, of Calgary, Calgary, AB, Canada
C.J. Doig
Affiliation:
Department of Medicine, University, of Calgary, Calgary, AB, Canada
C. Silva
Affiliation:
Department of Clinical Neurosciences, University, of Calgary, Calgary, AB, Canada
R.N. Auer
Affiliation:
Department of Clinical Neurosciences, University, of Calgary, Calgary, AB, Canada Department of Pathology, University of Calgary, Calgary, AB, Canada
C. Power
Affiliation:
Department of Clinical Neurosciences, University, of Calgary, Calgary, AB, Canada Department of Microbiology and Infectious Diseases, University, of Calgary, Calgary, AB, Canada
M.J. Gill
Affiliation:
Department of Microbiology and Infectious Diseases, University, of Calgary, Calgary, AB, Canada
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Abstract

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Background:

Infective endocarditis is associated with serious neurological sequelae.

Objective:

Here, we report a patient with Staphylococcus aureus endocarditis, secondary to congenital heart disease, with subacute onset of multiple neurological complications.

Results:

Despite prompt antibiotic treatment with rapid sterilization of blood cultures, the patient died with brain herniation within 96 hours of admission. Neuropathological examination showed intraparenchymal hemorrhages, mycotic aneurysms, micro-abscesses and septic arteritis with accompanying infarction. Immunocytochemical studies revealed enhanced CD45 and GFAP immunoreactivity, together with adenosine A1 receptor detection on macrophages and microglia.

Conclusion:

Infective endocarditis is associated with multiple neuropathological lesions, which may contribute to its poor clinical outcome and activation of cells of monocyte-microglial lineage throughout the brain.

Résumé:

RÉSUMÉ:<span class='bold'><span class='italic'>Introduction:</span></span>

L'endocardite infectieuse est associée à des séquelles neurologiques sérieuses. Objectif: Nous rapportons le cas d'un patient atteint d'un endocardite à staphyloccoque doré secondaire à une maladie cardiaque congénitale, qui a présenté des complications neurologiques à début subaigu impliquant de multiples hémorragies cérébrales et cérébelleuses.

<span class='bold'><span class='italic'>Résultats:</span></span>

En dépit d'une antibiothérapie établie promptement et d'une stérilisation des hémocultures, le patient est mort d'une hernie cérébrale, 96 heures après l'admission. L'examen neuropathologique a montré des hémorragies intraparenchymateuses, des anévrismes mycotiques, des micro-abcès et une artérite septique avec infarcissement. Les études immunohistochimiques ont montré une immunoréactivité CD45 et GFAP augmentées ainsi que la détection de récepteurs adénosine Al sur les macrophages et la microglie.

<span class='bold'><span class='italic'>Conclusions:</span></span>

L'endocardite infectieuse est associée à des lésions neuropathologiques multiples qui peuvent contribuer à un mauvais pronostic clinique et à l'activation de cellules de la lignée monocytique-microgliale dans tout le cerveau.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 28 , Issue 3 , August 2001 , pp. 260 - 264
Copyright
Copyright © The Canadian Journal of Neurological 2001

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