skip to main content

Endocarditis with Stroke — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

HardBone & Joint InfectionEndocarditis with StrokeSCE Infectious Diseases

A 65-year-old man is diagnosed with infective endocarditis and develops acute embolic stroke. CT head confirms a large right MCA territory infarct without haemorrhagic transformation. His vegetation is 15 mm and mobile. He is haemodynamically stable. When should cardiac surgery for vegetation removal be considered?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Early surgery (within days) is indicated for large vegetations (>10 mm) with embolic events, even after stroke — provided neurosurgical assessment confirms no contraindication

ESC 2023 endocarditis guidelines recommend early surgery (within days) for patients with large vegetations (>10 mm) plus embolic events, as the risk of further embolism is very high (~50% within 2 weeks). After embolic stroke, a multidisciplinary assessment (neurosurgery, neurology, cardiac surgery) should determine operative timing — surgery is generally safe if: the stroke is non-haemorrhagic, the infarct is not massive (affecting consciousness), and there is no haemorrhagic transformation. CT head should be repeated pre-operatively.

Reference: ESC 2023 – Endocarditis guidelines; AHA 2015 – IE and stroke