Pediatric Endocarditis and Stroke: A Single-Center Retrospective Review of Seven Cases

The acute management of strokes in children with infective endocarditis is limited by the paucity of published data on their clinical course and outcomes. Our retrospective study at an urban tertiary-care academic center characterized the clinical course of seven pediatric patients with endocarditis and subsequent cerebral infarcts. Among 115 patients with endocarditis, a stroke occurred in seven. Four patients manifested congenital heart disease. In six patients, the stroke occurred in the distribution of the middle cerebral artery, with no preference for the left or right hemisphere. The most common presenting sign was focal weakness. Three patients manifested mycotic aneurysms, all of which were successfully repaired. Two patients received aspirin therapy, with no adverse effects. All patients survived, but neurologic recovery was variable. The two youngest patients (aged 3 and 14 weeks) demonstrated the longest periods of hospitalization, with the most severe neurologic impairment. These findings suggest that children may have better outcomes than adults after a stroke secondary to bacterial endocarditis. Routine surveillance for mycotic aneurysms in patients with new neurologic deficits, and the use of aspirin, should be considered in the medical management.