Which of the following is a common CNS complication of infective endocarditis?

• A. Meningitis
• B. Embolic stroke in MCA
• C. Brain abscess
• D. Subdural empyema

Answer: (B)

In infective endocarditis, septic embolization from valvular vegetations frequently travels to the brain. The most common CNS complication is an ischemic stroke caused by an embolus occluding a cerebral artery, and it tends to affect the middle cerebral artery territory because of its large caliber and direct route from the internal carotid circulation. This presents with sudden focal neurologic deficits such as unilateral weakness or speech disturbance, reflecting the area of brain that becomes ischemic. While meningitis, brain abscess, or subdural empyema can occur in the setting of infection, they are less common CNS complications of endocarditis compared with an embolic ischemic stroke in the MCA territory.