Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of cerebral embolism caused by Cardiobacterium hominis endocarditis

Seigo Shindo, M.D.1), Teruyuki Hirano, M.D., Ph.D.1)2), Akihiko Ueda, M.D., Ph.D.1), Yasushi Maeda, M.D., Ph.D.1) and Yukio Ando, M.D., Ph.D.1)

1)Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
2)Department of Internal Medicine 3, Faculty of Medicine, Oita University

A 45-year-old woman was referred to our hospital by ambulance with left-sided palsy presented at dinner. Diffusionweighted magnetic resonance imaging (DWI) showed a somewhat high intensity area in the right frontal lobe, and brain magnetic resonance angiography (MRA) revealed right middle cerebral artery (MCA) occlusion in the M1 distal segment. Although intravenous rt-PA treatment was initiated at 2 hours and 10 minutes after onset, recanalization was not achieved. The patient was diagnosed as infectious endocarditis, because highly echogenic vegetation was observed in the non-coronary cusp of the aortic valve; furthermore, Cardiobacterium hominis was incubated in blood culture, although fever was not so high and C-reactive protein (CRP) was not elevated at the time of hospitalization. It was thought that the bacteremia and infectious endocarditis had occurred due to tooth extraction about six months previously. The diagnosis of infectious endocarditis caused by the HACEK group containing C. hominis may become difficult because the fever was not so high and inflammation was not so severe.
Full Text of this Article in Japanese PDF (9181K)

(CLINICA NEUROL, 53: 654|657, 2013)
key words: infectious endocarditis, Cardiobacterium hominis, HACEK group, rt-PA, dental therapy

(Received: 10-Jan-13)