Infective endocarditis is a systemic illness characterized by infection and inflammation of the endocardium which produces symptoms due to local causes and embolization.
One of the sites of embolism is the central nervous system. Cerebral magnetic resonance imaging (MRI) exhibits greater sensitivity than computed tomography (CT) when detecting covert lesions like cerebral microbleeds and asymptomatic embolisms.
There are specific patterns on cerebral MRI that prompt the diagnosis of infective endocarditis. This is a retrospective case series with the collection of data from 3 patients, who were encountered in the emergency and intensive care departments.
All three patients had clinical features secondary to a shower of multiple emboli detected on MRI brain as multiple bi-hemispheric and multi-circulation foci of diffusion restriction.
They were presumed initially to be cardioembolic in origin, which after targeted investigation were found to be due to infective emboli from IE.
Bi-hemispheric scattered diffusion restricting foci can mislead the treating physician into evaluation for stroke secondary to cardioembolism including the hunt for an occult atrial fibrillation which can delay treatment required in IE.
Distinguishing between septic and other cardioembolic lesions will result in the optimum management of such cases.
