Role of Neuro-Interventions and Surgery for Infectious Brain Complications

Infectious endocarditis (IE) is a devastating condition associated with several bacterial, fungal, and viral causes, with Staphylococcus aureus being the most common (Gupta and Mendez Endocarditis [Updated 2020 Apr 27]. In: StatPearls [Internet]. StatPearls Publishing, Treasure Island, 2020). Systemic complications can involve nearly every organ system in the body, with some of the most lethal complications involving the cerebrovascular system (Sotero et al. Curr Neurol Neurosci Rep 12:23, 2019; Morris et al. Neurohospitalist 4(4):213–222, 2014; Holland et al. Nat Rev Dis Primers 1(2):16059, 2016). Notably, cerebrovascular involvement of IE is not always symptomatically evident, as the cause(s) are often insidious. This presents a difficulty in management because the pathology can remain unnoticed for some time after onset (Morris et al. Neurohospitalist 4(4):213–222, 2014, Sonneville et al. Ann Intensive Care 20(1):10, 2011). Another difficulty in management stems from the lack of consensus regarding the impact of systemic neuroimaging on the direction of clinical decisions in critically ill patients with IE. However, neurologic involvement may immediately affect interventions, such as contraindicating early cardiac surgery (Gupta and Mendez Endocarditis [Updated 2020 Apr 27]. In: StatPearls [Internet]. StatPearls Publishing, Treasure Island, 2020). The purpose of this chapter is to describe the major neurological complications of IE and describe the techniques currently used to manage them, both surgical and nonsurgical.