Highlights
- •There is insufficient evidence for revascularization for Low NIHSS large vessel occlusion.
- •A rare case of infective endocarditis causes low NIHSS internal carotid artery occlusion.
- •Early thrombectomy resulted in a good course of treatment.
Abstract
Objectives
Large vessel occlusion (LVO)-related acute ischemic stroke due to infective endocarditis
(IE) is a rare condition. At onset, most patients are severely ill, whereas on rare
occasion, they develop mild neurological symptoms. As far as we are aware, this is
the first report of IE related internal carotid artery (ICA) occlusion with low National
Institutes of Health Stroke Scale (NIHSS) (<6) score treated with endovascular thrombectomy.
Case presentation
A 24-year-old woman had undergone dental treatment 3 weeks before and had a persistent
low-grade fever for a week. She presented to the emergency department with a chief
complaint of motor weakness of the right upper limb after waking up. She had only
mild paralysis of the right upper limb (NIHSS score 1). Magnetic resonance imaging
showed scattered infarcts in the left frontal lobe and cerebral angiography showed
that the left ICA had been occluded immediately distal to its origin. The symptom
disappeared after the occluded artery was completely recanalized by mechanical thrombectomy.
On postoperative day 1, blood cultures were positive and echocardiography was performed,
which revealed a verrucous mitral valve and a diagnosis of IE. On postoperative day
2, the patient underwent cardiac surgery for valve replacement. Thereafter, there
was no recurrence of cerebral infarction, and the patient was discharged home on day
50 with a modified Rankin Scale 0.
Conclusions
Early endovascular thrombectomy for low NIHSS score LVO due to IE resulted in a good
treatment course. IE should be part of the differential diagnosis of LVO in the young
patients.
Keywords
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References
- Neurological complications of infective endocarditis.Curr. Neurol. Neurosci. Rep. 2019; 19: 1-8
- Safety and efficacy of mechanical thrombectomy in infective endocarditis: a matched case – control analysis from the german stroke registry – endovascular treatment.Eur J Neurol. 2021; 28: 861-867
- Safety and outcomes of mechanical thrombectomy for acute stroke related to infective endocarditis: a case–control study.Int J Stroke. 2021; 16: 585-592
- Short-term aneurysm formation and rupture due to septic embolism diagnosed with a thrombus retrieved from another occluded artery.Surg Neurol Int. 2022; 13: 1-7
- Endovascular treatment of ischemic large-vessel stroke due to infective endocarditis: case series and review of the literature.Neurol Sci. 2020; 41: 3517-3525
- Endovascular treatment of infective endocarditis-related acute large vessel occlusion stroke.J. Stroke Cerebrovasc Dis. 2021; 30105775
- Complex decision-making in stroke: preoperative mechanical thrombectomy of septic embolus for emergency cardiac valve surgery.BMJ Case Rep. 2014; 2014: 1-5
- Successful thrombectomy in endocarditis-related stroke: case report and review of the literature.Interv Neuroradiol. 2018; 24: 529-532
- Mechanical thrombectomy for acute ischemic stroke secondary to infective endocarditis.Clin Infect Dis. 2018; 66: 1286-1289
- Management of large vessel occlusion stroke related to infective endocarditis: is mechanical thrombectomy a safe option?.J Stroke Cerebrovasc Dis. 2020; 29105248
- Minor stroke due to large artery occlusion. When is intravenous thrombolysis not enough? Results from the SITS international stroke thrombolysis register.Eur Stroke J. 2018; 3: 29-38
- Proximal arterial occlusion in acute ischemic stroke with low NIHSS scores should not be considered as mild stroke.PLoS One. 2013; 8: e70996
- Impact of thrombus migration on clinical outcomes in patients with internal carotid artery occlusions and patent middle cerebral artery.J. Neurol. Sci. 2020; 412116737
Article info
Publication history
Published online: December 17, 2022
Accepted:
November 27,
2022
Received in revised form:
November 20,
2022
Received:
October 17,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106915
Copyright
© 2022 Elsevier Inc. All rights reserved.
