回收血栓病理确诊的感染性心内膜炎致急性脑梗死一例

Pathology of retrieved thrombus in a patient with acute ischemic stroke due to infective endocarditis: a case report

感染性心内膜炎(infective endocarditis,IE)的感染性赘生物脱落栓塞是引起脑卒中的病因之一。近年急性缺血性卒中机械取栓术在国内外广泛开展,但是国内通过回收血栓的病理检查确认卒中病因的报道较少见。现报道1例回收血栓病理确诊的IE所致急性脑梗死患者。患者为33岁男性,既往有扩张性心肌病病史,主因"突发左侧肢体麻木力弱14 h"就诊,行机械取栓术,回收血栓病理检查发现革兰阳性球菌。患者入院后出现高热、脓毒性休克、急性肾衰竭,超声心动图显示左心室附壁血栓,因此确诊为IE所致急性脑梗死。

Infective endocarditis is one of the causes of cerebral infarction. Mechanical thrombectomy has been widely used in China for years. However, reports involving retrieved thrombus pathology are somewhat scarce. Here a case in which the cause of stroke was confirmed by thrombus pathology is reported. A 33-year male with a history of dilated cardiomyopathy visited the emergency because of sudden onset of left-sided weakness for 14 hours. Mechanical thrombectomy was performed, and the pathological study of the retrieved thrombus demonstrated Gram-staining positive cocci. The patient was combined with fever, septic shock, and acute kidney injury. Ultrasoundcardiography showed vegetation in the left ventricle. Therefore, he was definitely diagnosed as acute ischemic stroke due to infective vegetation embolism.