Case Of the Week (COW) 19 June 2016
Septic-embolic encephalitis
Findings
Proven case of infective endocarditis diagnosed by echocardiography & blood culture. MRI reveals multifocal tiny randomly distributed acute infarcts involving cortical and subcortical areas of both cerebral hemispheres and bilateral cerebellar hemispheres.Late subacute hemorrhage in right thalamus.Diffuse leptomeningeal enhancement with prominent leptomeningeal vessels.
Discussion
Septic-embolic encephalitis (SEE), also known as septic-embolic brain abscess, refers to a focal or diffuse brain infection, ischaemic and haemorrhagic damages following an infective thromboembolism from any part of the body. It is usually caused by bacterial infections from endocarditis.Risk factors include rheumatic cardiovascular disease ,mitral valve prolapse ,prosthetic heart valves &congenital heart disease. Occlusion of cerebral arteries by septic emboli arising from heart valve vegetations can result in focal ischaemia, cerebral haemorrhage or both.Contrast-enhanced images are essential to evaluate abscess formation. Local arteritis can promote mycotic aneurysm formation and vascular rupture.
Septic-embolic encephalitis
Findings
Proven case of infective endocarditis diagnosed by echocardiography & blood culture. MRI reveals multifocal tiny randomly distributed acute infarcts involving cortical and subcortical areas of both cerebral hemispheres and bilateral cerebellar hemispheres.Late subacute hemorrhage in right thalamus.Diffuse leptomeningeal enhancement with prominent leptomeningeal vessels.
Discussion
Septic-embolic encephalitis (SEE), also known as septic-embolic brain abscess, refers to a focal or diffuse brain infection, ischaemic and haemorrhagic damages following an infective thromboembolism from any part of the body. It is usually caused by bacterial infections from endocarditis.Risk factors include rheumatic cardiovascular disease ,mitral valve prolapse ,prosthetic heart valves &congenital heart disease. Occlusion of cerebral arteries by septic emboli arising from heart valve vegetations can result in focal ischaemia, cerebral haemorrhage or both.Contrast-enhanced images are essential to evaluate abscess formation. Local arteritis can promote mycotic aneurysm formation and vascular rupture.