Symptomatické neurologické komplikácie sa vyskytujú u 15-30 % pacientov s infekčnou endokarditídou. Zároveň sa u 35-60 % pacientov vyskytujú klinicky nemé mozgové embólie. Staphylococcus aureus je patogén, ktorý najčastejšie spôsobuje postihnutie nervového systému. Uvádzame prípad 67-ročného muža s infekčnou endokarditídou po stomatologickom výkone, ktorý sa prejavil ako spondylodiscitída a mnohopočetná embolizácia do mozgu, vrátane mozgového abscesu, ktorý si vyžiadal neurochirurgickú drenáž. Po 6 týždňoch liečby širokospektrálnymi antibiotikami a komplexnej podpornej terapii sme pacienta prepustili v uspokojivom somatickom a psychickom stave. Pokračuje príprava pacienta na kardiochirurgický výkon.

Symptomatic neurological complications occur in 15-30% of patients with infective endocarditis. At the same time, other clinically silent cerebral embolisms occur in 35-60% of patients. Staphylococcus aureus is the pathogen that causes nervous system involvement most frequently. We report a case of a 67-year-old man with infective endocarditis following a dental procedure that manifested as spondylodiscitis and multiple brain embolization, including a brain abscess that required drainage. After six weeks of treatment with broad-spectrum antibiotics and complex supportive therapy, we discharged the patient in a satisfactory mental and somatic condition. The preparation of the patient for cardiac surgery is ongoing.

• MeSH
• absces mozku diagnostické zobrazování   etiologie   patologie   terapie   MeSH
• discitida diagnostické zobrazování   komplikace   patologie   MeSH
• echokardiografie transezofageální MeSH
• endokarditida * diagnostické zobrazování   farmakoterapie   komplikace   patologie   terapie   MeSH
• extrakce zubů škodlivé účinky   MeSH
• intrakraniální embolie * diagnostické zobrazování   komplikace   patologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mitrální insuficience diagnostické zobrazování   etiologie   farmakoterapie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH

INTRODUCTION: Elderly cryptogenic ischemic stroke (IS) patients with embolic stroke of undetermined source (ESUS) have a high risk of recurrent IS (RIS) compared to other stroke subtypes. In young ESUS patients, different sources of embolism may be a cause and the risk of RIS remains not enough established. The aim was to assess and compare risk of RIS between ESUS and non ESUS patients <50 years. METHODS: The study set consisted of young acute IS patients <50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study registered on ClinicalTrials.gov (NCT01541163). In all analyzed patients, the brain ischemia was confirmed on CT or MRI. All patients underwent identical diagnostic protocol including TEE and long-term ECG-Holter. Cause of IS was assessed according to the ASCOD classification. RESULTS: Of 320 enrolled patients <50 years, 219 (68.4%) were identified as cryptogenic (119 males, mean age 41.4 ± 7.2 years) and 122 (38.1%) patients fulfilled the ESUS criteria. During the follow-up with a median of 34 months, three (2.5%) ESUS and 5 (5.2%) non-ESUS patients suffered from RIS (p = .471). One-year risk of RIS was 0.008 (95% CI: 0-0.025) for ESUS and 0.036 (95% CI: 0-0.076) for non-ESUS patients (p = .262). CONCLUSION: The risk of RIS was very low in ESUS patients and did not differ from those with non-ESUS. Our finding may indicate that antiplatelet therapy can be effective in the secondary prevention in young ESUS patients if high-risk sources of embolization are excluded extensively.

• MeSH
• cévní mozková příhoda * diagnostické zobrazování   epidemiologie   etiologie   MeSH
• dospělí MeSH
• embolická cévní mozková příhoda * MeSH
• intrakraniální embolie * komplikace   diagnostické zobrazování   epidemiologie   MeSH
• ischemická cévní mozková příhoda * MeSH
• ischemie mozku * komplikace   diagnostické zobrazování   epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND AND PURPOSE: Risks, sites, and predictors of major bleeding during antithrombotic therapies have not been well defined for patients with recent embolic stroke of undetermined source. METHODS: Exploratory analysis of major bleeds defined by International Society of Thrombosis and Hemostasis criteria occurring among 7213 participants in international NAVIGATE (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial) embolic stroke of undetermined source randomized trial comparing rivaroxaban 15 mg daily with aspirin 100 mg daily. RESULTS: During a median follow-up of 11 months, 85 major bleeds occurred. The most frequent site was gastrointestinal (38%), followed by intracranial (29%). Assignment to rivaroxaban (hazard ratio [HR], 2.7 [95% CI, 1.7-4.3]), East Asia region (HR, 2.5 [95% CI, 1.6-3.9]), systolic blood pressure ≥160 mm Hg (HR, 2.2 [95% CI, 1.2-3.8]), and reduced estimated glomerular filtration rate (HR, 1.2 per 10 mL/min per 1.73 m2 decrease, [95% CI, 1.0-1.3]) were independently associated with presence of major bleeds. Five (6%) were fatal. Among 15 patients with intracerebral hemorrhage, 2 (13%) were fatal. There was no evidence of an early high-risk period following initiation of rivaroxaban. The annualized rate of intracerebral hemorrhage was 6-fold higher among East Asian participants (0.67%) versus all other regions (0.11%; HR, 6.3 [95% CI, 2.2-18.0]). Distribution of bleeding sites was similar for rivaroxaban and aspirin. CONCLUSIONS: Among embolic stroke of undetermined source patients participating in an international randomized trial, independent predictors of major bleeding were assignment to rivaroxaban, East Asia region, increased systolic blood pressure, and impaired renal function. East Asia as a region was strongly associated with risk of intracerebral hemorrhage. Estimated glomerular filtration rate should be a consideration for stratifying bleeding risk. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02313909.

• MeSH
• Asijci MeSH
• cerebrální krvácení chemicky indukované   MeSH
• cévní mozková příhoda etiologie   prevence a kontrola   MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• hodnoty glomerulární filtrace MeSH
• inhibitory faktoru Xa škodlivé účinky   MeSH
• intrakraniální embolie komplikace   MeSH
• krvácení chemicky indukované   MeSH
• lidé středního věku MeSH
• lidé MeSH
• rivaroxaban škodlivé účinky   MeSH
• rizikové faktory MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Geografické názvy
• Dálný východ MeSH