**7. Uncommon neurologic presentations**

This section will discuss a heterogeneous group of less common manifestations of SE affecting the CNS, including extracranial involvement. The paucity of published literature in this broad topic area is likely due to limited awareness and under-recognition of such clinical presentations. Within the microcosm of SE associated with IE, approximately 30–40% of events involve neurological manifestations [10, 122]. Beyond the more commonly seen complaints (e.g., stroke, transient ischemic attack, meningitis, brain abscess) within this subset, less frequently reported clinical manifestations may include visual loss, seizures, acute mononeuropathy, and even spinal cord involvement [122–124]. Septic emboli can migrate to the spinal cord, causing segmental infarction [122, 123]. These exceedingly rare events have the potential to result in severe disability and often accompany additional, simultaneous SE to other anatomic regions [10].

therapy [136]. Any SE to end organs or associated arterial aneurysms also warrant immediate surgical evaluation and prompt intervention. As mentioned earlier in the chapter, emboli to different anatomic regions may require distinct plans and different timing in terms of surgical intervention [50]. The diagnosis of prosthetic valve endocarditis constitutes another major indication for surgical intervention. Patients who present within 60 days of discharge following the placement of a new prosthetic valve with persistent fevers should be evaluated for the presence of IE, and if proven to harbor such infection should undergo operative management. It is important to remember that roughly 25% of prosthetic valve patients may

Septic Embolism in Endocarditis: Anatomic and Pathophysiologic Considerations

http://dx.doi.org/10.5772/intechopen.76766

161

Despite significant clinical research and advances in clinical management, septic embolism associated with infectious endocarditis continues to be a diagnostic and therapeutic challenge. Given the increasing number of intravascular and intracardiac device implantations, as well as the greater prevalence of chronic comorbid conditions, it is not surprising that the incidence of both infectious endocarditis and septic embolism has followed suit. In this chapter, we outlined general pathophysiologic and anatomic considerations with which all physicians should be familiar. This important knowledge should serve to assist providers in maintaining a high level of clinical suspicion for potential IE and/or SE. Given the continued high rates of associated disability and mortality, more research is needed to better understand and treat

, Santo Longo3

1 Department of Research and Innovation, St. Luke's University Health Network,

2 Center for Neurosciences, St. Luke's University Health Network, Bethlehem, Pennsylvania,

3 Department of Pathology, St. Luke's University Health Network, Bethlehem, Pennsylvania,

[1] Osler W.Gulstonian lectures on malignant endocarditis. The Lancet. 1885;**125**(3210):415-418 [2] Alpert JS, Klotz SA. Infective endocarditis. In: Fuster V et al., editors. Hurst's the Heart.

and Stanislaw P. Stawicki1

\*

be at risk of IE [136, 141].

these "low-frequency, high-impact" events.

, Daniel Ackerman2

\*Address all correspondence to: stawicki.ace@gmail.com

14th ed. New York, NY: McGraw-Hill Education; 2017

**9. Conclusions**

**Author details**

Bethlehem, Pennsylvania, USA

Vikas Yellapu<sup>1</sup>

USA

USA

**References**
