Korean Circ J.  2011 Aug;41(8):490-493. 10.4070/kcj.2011.41.8.490.

Hemorrhagic Transformation of Ischemic Stroke: Severe Complications of Prosthetic Valve Endocarditis

• Kim JS
• Yang WI
• Shim CY
• Ha JW
• Chung N
• Chang HJ

• KMID: 1826360
• DOI: http://doi.org/10.4070/kcj.2011.41.8.490

Abstract

Ischemic stroke is a common complication of infective endocarditis (IE), occurring in 20-40% of left side IE cases. In these subsets, anticoagulation therapy may provoke hemorrhagic transformation (HT) of ischemic stroke, and complications of this magnitude deteriorate the clinical course for IE patients. However, in cases of IE complicated with a mechanical prosthetic valve, the physician can be concerned over the maintenance of anticoagulation due to the risk of thrombotic complication. According to our retrospective review, HT of ischemic stroke in prosthetic valve endocarditis occurred 13.8% (4/29) of the time in a variety of situations. Some of these even arose in patients with a subtherapeutic range of prothrombin time.

Keyword

Heart valve prosthesis; Endocarditis; Stroke; Cerebral hemorrhage; Anticoagulants

MeSH Terms

Anticoagulants
Cerebral Hemorrhage
Endocarditis
Heart Valve Prosthesis
Humans
Prothrombin Time
Retrospective Studies
Stroke
Anticoagulants

Figure

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  Fig. 1 Brain magnetic resonance imaging on day 3 of hospitalization revealed multiple acute infarcts on diffusion-weighted images, suggesting an embolic origin (A and B). Non-contrast brain computed tomography on day 10 of hospitalization revealed hemorrhagic transformation of the previous embolic infarct at the left temporoparietal area and subfalcial herniation due to the mass effect of the hemorrhage (C and D).

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  Fig. 2 Study flows.

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