From the Guidelines
Strokes and endophthalmitis can both be caused by serious underlying medical conditions, with strokes primarily resulting from interruption of blood flow to the brain and endophthalmitis typically caused by infection. The causes of these two conditions are distinct but can sometimes be linked by common risk factors or underlying diseases. Strokes are mainly caused by either blockage (ischemic stroke) or bleeding (hemorrhagic stroke) in the brain, with risk factors including hypertension, diabetes, smoking, high cholesterol, atrial fibrillation, and carotid artery disease 1. On the other hand, endophthalmitis, an inflammation of the internal eye tissues, is usually caused by infection, which can occur after eye surgery, eye trauma, or from bloodborne infections spreading to the eye (endogenous endophthalmitis) 1. Common pathogens for endophthalmitis include Staphylococcus, Streptococcus, and fungi, with certain conditions like diabetes, intravenous drug use, and immunosuppression increasing the risk of endogenous endophthalmitis 1. In rare cases, infective endocarditis can cause both conditions simultaneously, as bacteria from heart valve infections can embolize to both the brain (causing stroke) and the eye (causing endophthalmitis) 1. Prompt treatment is essential for both conditions, with anticoagulants or thrombolytics used for ischemic stroke and intravitreal antibiotics for endophthalmitis, often combined with systemic antibiotics 1. It's also important to consider the role of inflammation and infection in the development of stroke, as chronic infections and inflammatory diseases can increase the risk of stroke 1. Overall, understanding the causes and risk factors for strokes and endophthalmitis is crucial for providing effective treatment and preventing these serious medical conditions. Key considerations include:
- Identifying and managing risk factors for stroke and endophthalmitis
- Promptly treating ischemic stroke with anticoagulants or thrombolytics and endophthalmitis with intravitreal antibiotics
- Recognizing the potential link between infective endocarditis and both stroke and endophthalmitis
- Considering the role of inflammation and infection in stroke development.
From the Research
Causes of Stroke and Endophthalmitis
- Infective endocarditis is a known cause of stroke, as it can lead to the formation of blood clots that can travel to the brain and cause an ischemic stroke 2, 3, 4, 5
- The risk of stroke is increased in patients with infective endocarditis due to the potential for septic embolism, which can carry bacteria or other infectious material to the brain 4, 5
- Endocarditis can also increase the risk of endophthalmitis, a serious eye infection that can occur when bacteria or other infectious material enter the eye 2, 3, 4, 5
- Other factors, such as arterial hypertension, can also increase the risk of stroke, and may be addressed through the use of antihypertensive drugs 6
- The use of thrombolytic therapy, such as intravenous tissue plasminogen activator, may be contraindicated in patients with infective endocarditis due to the increased risk of intracranial hemorrhage 2, 3
Treatment and Management
- Thrombectomy may be a safer treatment option than thrombolysis or combined treatment for patients with infective endocarditis-associated stroke 3
- Early surgery may improve outcomes in patients with infective endocarditis, but may also carry risks such as hemorrhagic transformation and neurological deterioration 4
- The use of antihypertensive drugs may be beneficial in reducing the risk of recurrent stroke in patients with a history of ischemic stroke or transient ischemic attack 6