Research Article

Ischemic Stroke Revealing Infectious Endocarditis : Two Cases Reports in Lome (Togo)

Authors: Pessinaba Soulemane, Afassinou Yaovi Mignazonzon, Djolla Epé R. Claudia, Aguezo Kokou, Kpélafia Mohamed, Yayehd Komlavi, Togbossi Ekpé, Kaziga Wiyaou-Dieudonné, Apétse Kossi, Pio Machihude, Baragou Soodougoua, Balogou Agnon, Damorou Findibe.

DOI: 10.33425/2639-8486.1216

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Abstract

Introduction: Infective endocarditis (IE) is a severe condition which is often not diagnosed until it is in an advanced stage, particularly in low-resource settings. Neurological complications, particularly ischaemic stroke, are major contributors to morbidity and mortality. In this article, we present two cases of IE that were revealed by ischaemic stroke, in order to highlight the diagnostic and therapeutic challenges in this context.

Case presentations: The first case was a 17-year-old girl who had an ischemic stroke caused by Staphylococcus aureus endocarditis on a structurally normal mitral valve. The second case was an eight-year-old boy with rheumatic mitral valve endocarditis. Diagnosis was based on the modified Duke criteria. Echocardiography revealed large mitral vegetations and severe regurgitation. Both patients received prolonged antibiotic therapy instead of surgery due to a lack of technical facilities. The clinical outcome was favourable in both cases.

Conclusion: Ischemic stroke may be the first sign of infective endocarditis, even in a native valve. In low-resource settings, any prolonged fever accompanied by a focal neurological deficit should prompt an investigation for IE. Early diagnosis, echocardiographic screening and the establishment of cardiac surgery units are crucial to improving outcomes.

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