WHAT HAPPENS WHEN YOU TREAT SEPTIC CEREBRAL EMBOLI WITH INTRAVENOUS THROMBOLYTIC TREATMENT? A CASE REPORT
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Tarih
2022
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info:eu-repo/semantics/openAccess
Özet
Infective endocarditis (IE) is the infection of the endocardial surfaces of the heart and intracardiac foreign bodies, and is caused by various microorganisms such as bacteria, fungus and viruses. Most common findings of IE include cardiac murmur, splenomegaly, Osler nodes, splinter hemorrhages, and Janeway lesions. Here, we aimed to present a IE case which was misdiagnosed as thromboembolic stroke, treated with intravenous (IV) thrombolytic treatment and developed multiple cerebral and cerebellar hemorrhages. A 35-year-old man with a history of diabetes mellitus (DM) and hypertension (HT) was admitted to our clinic with multiple cerebral and cerebellar hemorrhages. It was found out that the patient was given an antibiotic treatment due to high fever (39-40 oC) and pharyngitis two weeks before admission to our clinic, and a week later he developed right side weakness. As computerised tomography (CT) and diffusion-weighted magnetic resonance imaging (MRI) were normal at the clinic the patient applied with right sided weakness, he was diagnosed with acute ischemic stroke and was given intravenous thrombolytic treatment-alteplase (IV rTPA). Patient was referred to our clinic due to persistent fever, clinical worsening and multiple cerebral and cerebellar hemorrhages in follow-up CT scan. The patient was referred to the Cardiology clinic with the preliminary diagnosis of infective endocarditis. Echocardiography (ECO) showed a thrombotic vegetation measuring 1.1 x 0.7 centimeters (cm) on the anterior mitral valve, and transoesophageal ECO showed a thrombotic vegetation measuring 1.9 x 0.9 on the mitral valve. The patient was referred to Infctious Diseases clinic for initiation of antibiotherapy, and Cardiovascular Surgery clinic regarding the need for surgery. Yet, as the surgery required high-dose heparin application, an operation was not performed. After the treatment, hemorrhage areas were seen to be regressed in follow-up brain CT scan. While evaluating patients who admit to the emergency with high fever and neurological deficits, septic embolism should also be kept in mind at the first visit and imaging methods should be used for further evaluation.
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Türk Beyin Damar Hastalıkları Dergisi
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28
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1
