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Brain embolization is a well-known complication of left-sided infective endocarditis (IE) and can be the initial clinical clue for diagnosing the syndrome. Unfortunately, emboli sometimes remain silent until patients have suffered devastating consequences — for example, a brain hemorrhage following anticoagulant use for pump bypass during valve surgery. To determine how often such subclinical brain embolization (SCBE) occurs, investigators at a Washington, D.C., medical center prospectively studied 56 patients with definite left-sided IE.
Among the 40 patients who underwent magnetic resonance imaging (MRI), 32 (80%) had acute brain embolization (clinical stroke in 13 [33%] and SCBE in 19 [48%]). In the subgroup of patients who had MRIs and w…