“Transcranial Doppler Emboli Monitoring for Infective Endocarditis” by G Huang, LL Johnson, JE Peacock Jr, C Tegeler, K Davis, and A Sarwal. Online now at https://lnkd.in/dQYgyKg. Infective endocarditis (IE) has variable clinical manifestations with a complex of complications presenting as symptoms. Some neurological complications of IE are embolic stroke, intracerebral hemorrhage, and brain abscess. Ischemic stroke can occur in 20-55% of patients with IE (often during the first 2 weeks of treatment).
Brain CT or MRI can diagnose stroke sequelae but transcranial Doppler (TCD) can document active embolization. The authors undertook a retrospective review of their patient cohort (n=89) and made a systematic literature review to assess the role of TCD in early diagnosis of ischemic stroke in IE.
In patients with suspected IE, TCD monitoring for high-intensity transient signals (HITS) could assist in confirming the diagnosis of IE by providing evidence of vascular phenomena where echocardiographic evidence of cardioembolic source is lacking. Furthermore, TCD monitoring may provide insight into stroke risk, as well as assess risk-benefit for early surgical interventions, whether open or minimally invasive.