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Abstract Details

Stroke in Non-Bacterial Thrombotic Endocarditis: 31-Year Experience
Cerebrovascular Disease and Interventional Neurology
P02 - (-)
023
BACKGROUND: Cancer-related stroke has been described in the literature. There is little knowledge about stroke in 'definite' NBTE, a rare but important cause of stroke.
DESIGN/METHODS: We reviewed data of patients with discharge ICD-9 codes for endocarditis, 1980-2011. NBTE was 'definite' if vegetations were seen on cardiac echo or autopsy in patients with predisposing conditions (e.g. cancer, lupus). Stroke was confirmed by CT/MRI.
RESULTS: Of 1186 hospitalizations with endocarditis, 35 had 'definite' NBTE confirmed by echo (66%) or autopsy (34%). Ischemic stroke occurred in 26 (74%) patients with NBTE, including one with infarcts plus ICH; stroke was the only manifestation in 20%. NBTE was secondary to cancer in 25 patients (71%) including 20 with stroke and 5 without stroke. As compared to the NBTE-non.stroke group, the NBTE-stroke group tended to be older (65y vs. 56y, p=0.07) and had higher D-dimer levels, but there were no significant differences in traditional vascular risk factors or other hematological parameters. Most stroke patients developed total or partial anterior circulation stroke syndromes (53%), none had lacunar syndrome, and 11% developed 'embolic encephalopathy'. On brain imaging, infarcts involved the cortex in 89%, deep gray 62%, brainstem 12%, and cerebellum 42%. Six patients (23%) developed in-hospital stroke recurrence, and one (4%) developed symptomatic post-ischemic hemorrhage. The frequency of anticoagulation was similar between the NBTE-stroke and non-stroke groups (p=0.14). In the NBTE-stroke group, 5/14 developed recurrent stroke despite anticoagulant use, vs. 1/12 who were not anticoagulated (p=0.17). Mean length of stay in NBTE-stroke was 19卤17 vs. 15卤9 days in NBTE-non.stroke (p=0.4). The NBTE-stroke group had higher mortality (58% vs. 0%, p=0.004).
CONCLUSIONS: This 31-year analysis shows that stroke is a frequent complication of NBTE, has severe clinical and radiological manifestations, and high associated mortality. Anticoagulation may not prevent stroke recurrence.
Authors/Disclosures

PRESENTER 		No disclosure on file
No disclosure on file
No disclosure on file
Ferdinando Buonanno, MD (Massachusetts General Hospital) No disclosure on file
Aneesh B. Singhal, MD, FAAN (Massachusetts General Hospital) An immediate family member of Dr. Singhal has received personal compensation for serving as an employee of Biogen. Dr. Singhal has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal Firms. Dr. Singhal has received research support from NIH-NINDS. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received personal compensation in the range of $500-$4,999 for serving as a Honorarium (好色先生) with Biogen.
Michael S. Okun, MD, FAAN (University of Florida) Dr. Okun has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Okun has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Parkinson's Foundation. Dr. Okun has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Okun has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Journal Watch. The institution of Dr. Okun has received research support from NIH. The institution of Dr. Okun has received research support from Parkinson's Foundation. The institution of Dr. Okun has received research support from Tourette Association of America. The institution of Dr. Okun has received research support from Michael J Fox. Dr. Okun has received publishing royalties from a publication relating to health care.