Significant Increase in Mortality and Risk of Acute Ischemic Stroke in Infective Endocarditis Patients With Subarachnoid Hemorrhage Secondary to Mycotic Aneurysms

Authors

Tolga Sursal, Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA.
Kevin Clare, New York Medical College School of Medicine, Valhalla, NY 10595, USA.
Eric Feldstein, Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA.
Jonathan Ogulnick, New York Medical College School of Medicine, Valhalla, NY 10595, USA.
Bridget Nolan, New York Medical College School of Medicine, Valhalla, NY 10595, USA.
Zafar Karimov, New York Medical College School of Medicine, Valhalla, NY 10595, USA.
Andrew Nazarenko, New York Medical College School of Medicine, Valhalla, NY 10595, USA.
Linda Ye, New York Medical College School of Medicine, Valhalla, NY 10595, USA.
Yarden Bornovski, Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA.
Serena Wong, Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA.
Joshua Goldberg, Section of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.
Stephan A. Mayer, Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA.
Andrew Bauerschmidt, Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA.
Marc Y. El Khoury, Department of Medicine, Division of Infectious Diseases, Westchester Medical Center, New York Medical College School of Medicine, Valhalla, NY 10595, USA.
Hosam Al-Jehani, Neurosurgery, Imam Abdulrahman Bin Faisal University King Fahd Hospital of the University, Alkhobar, Saudi Arabia.
Chirag D. Gandhi, Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA; New York Medical College School of Medicine, Valhalla, NY 10595, USA.
Fawaz Al-Mufti, Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA; New York Medical College School of Medicine, Valhalla, NY 10595, USA. Electronic address: fawaz.al-mufti@wmchealth.org.Follow

Author Type(s)

Student, Resident/Fellow, Faculty

Journal Title

Journal of the Neurological Sciences

First Page

120670

Document Type

Article

Publication Date

8-15-2023

Department

Surgery

Second Department

Neurology

Third Department

Medicine

Abstract

Infective Endocarditis (IE) patients are known to have a variety of complications with one of the rarest, but serious being cerebral mycotic aneurysm, which can result in subarachnoid hemorrhage (SAH). Using the National In-Patient Sample database, we sought to determine the rate of acute ischemic stroke (AIS) and outcomes in IE- patients with and without SAH. In total, we identified 82,844 IE-patients from 2010 to 2016, of which 641 had a concurrent diagnosis of SAH. IE patients with SAH had a more complicated course, higher mortality rate (OR 4.65 CI 95% 3.9-5.5, P < 0.001), and worse outcomes. This patient population also had a significantly higher rate of AIS (OR 6.3 CI 95% 5.4-7.4, P < 0.001). Overall, 41.5% of IE-patients with SAH had AIS during their hospitalization as compared to 10.1% of IE only patients. IE-patients with SAH were more likely to undergo endovascular treatment (3.6%) with 0.8% of the IE patients with AIS undergoing mechanical thrombectomy. While IE-patients are at risk for various complications, our study suggests a significant increase in the mortality and risk of AIS in those with SAH.

Recommended Citation

Sursal, T., Clare, K., Feldstein, E., Ogulnick, J., Nolan, B., Karimov, Z., Nazarenko, A., Ye, L., Bornovski, Y., Wong, S., Goldberg, J., Mayer, S. A., Bauerschmidt, A., El Khoury, M. Y., Al-Jehani, H., Gandhi, C. D., & Al-Mufti, F. (2023). Significant Increase in Mortality and Risk of Acute Ischemic Stroke in Infective Endocarditis Patients With Subarachnoid Hemorrhage Secondary to Mycotic Aneurysms. Journal of the Neurological Sciences, 451, 120670. https://doi.org/10.1016/j.jns.2023.120670