Complicated Ruptured Mycotic Intracerebral Emboli from Infective Endocarditis Presenting Like Meningoencephalitis
- Author:
NORHAYATI R
1
Author Information
1. Department of Emergency Medicine , Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
- Collective Name:NORHAYATI R; AFLIZA AB; DAZLIN MS; IDA ZZ
- Publication Type:Case Reports
- Keywords:
chronic;
endocarditis;
headache;
infective;
meningoencephalitis
- From:Medicine and Health
2019;14(1):259-265
- CountryMalaysia
- Language:English
-
Abstract:
Infective endocarditis (IE) is a potentially life-threatening disease which carries
high risk of morbidity and mortality. The variability of clinical presentation of
infective IE remains a diagnostic challenge for the Emergency Physicians. The
clinical manifestation may present as an acute, rapidly progressive infection with
the absence of classical immunological vascular phenomenon or as subacute
or chronic disease with vague constitutional symptoms that may mislead initial
assessment and mimic other conditions. Symptoms may also manifest as a result
of systemic embolization which can be catastrophic and life-threatening especially
if it ends up in the cerebral circulation. IE complicated by cerebral mycotic
aneurysm (CMA) is the worst neurological sequalae and can be misdiagnosed as
a primary intracranial infection such as meningoencephalitis. Here, we report a
case of neurological emergency secondary to systemic embolization of IE with a
devastating diagnosis of CMA. History of prolonged fever associated with headache
and focal neurological deficit led to the initial diagnosis of meningoencephalitis
due to a low clinical suspicion of the disease in the Emergency Department. In
emergency setting, a combination of high degree of clinical suspicion together
with thorough history, physical examination and diagnostic imaging are crucial in
order to guide and establish the diagnosis of this potentially devastating disease.
Early recognition and initiation of aggressive treatment is crucial to provide better
prognosis and higher survival rate for patients with CMA.
- Full text:12.2019my0110.pdf