brutus25
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16. A 67-year-old man is brought to the emergency department because of a 3-day history of fever and headache. Five years ago, he underwent placement of a mechanical aortic valve for treatment of sequelae of rheumatic fever. He appears ill. His temperature is 40 C (104 F), blood pressure is 110/65 mm Hg, pulse is 110/min, and respirations are 22/min. A grade 3/6, systolic ejection murmur is heard. Neurologic examination shows mild left hemiparesis. Babinski's sign is present on the left. There is no nuchal rigidity. This patient is at greatest risk for which of the following complications?
A) Brain abscess
B) Carotid artery occlusion
C) Encephalitis
D) Hydrocephalus
E) Venous sinus thrombosis
Sincerely I would go w/ A but not sure
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| Korotkoff
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A
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| farnsworth
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hmmmm, I would go for B (just because I like to object to any answer previously given ;-)
The patient has most probably an ill functioning mechanical aortic valve, maybe due to endocarditis (parts of the valve become endothelialized) -> thrombus formation. Thrombi from the left heart like to go right up the carotid artery and clog vessels in the brain (e. g. the medial cerebral artery, which is a branch of the internal carotid artery). Appositional growth of the thrombi can, at least in theory, lead to occlusion of the carotid artery.
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| farnsworth
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why not A?
I think that in most of the cases, brain abscesses result from inflammation of adjacent structures (sinuses, middle ear, mastoid bone etc). Inflammation of the brain occurs per continuitatem.
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| Korotkoff
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Even though it is rare, brain abscess is one of the complications of IE.
Is carotid artery occlusion complication of IE too?
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| farnsworth
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korotkoff: don't know. Have seen a handfull of brain abscesses from otitis, sinusitis, and even of dental origin, but none from IE. It was just an educated guess...
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| sherry39
Forum Junior
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BBBBBBBBBB...prophylaxis of warfarinis given therefore in every valve replaced patient to prevent thromboembolic phenomenon
also complication of IE is due to..1.septic emboli..2...immmune complex deposition
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| guangyu
Forum Elite
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B, the only reasonable choice from IE is B
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| Miradautas Vras
Forum Senior
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Drive here is to think about cardiac embolism. only arterial embolus in choice is B. Though systemic septicemia can cause all [may be except venous thrombosis] , given the presentation of embolic storke ,I think it's B.
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