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Medline ® Abstract for Reference 17

of 'Nonbacterial thrombotic endocarditis'

Fatal cerebroembolism from nonbacterial thrombotic endocarditis in a trauma patient: case report and review.
Sharma S, Mayberry JC, Deloughery TG, Mullins RJ
Mil Med. 2000 Jan;165(1):83-5.
Nonbacterial thrombotic endocarditis (NBTE) is a rare condition that may result in an unexpected and usually fatal cerebroembolism. It occurs in a variety of clinical situations, including malignancy, immune disorders, and sepsis, but it has rarely been reported after trauma. The formation of NBTE appears to require a hypercoagulable state and changes in valvular morphology, e.g., during a hyperdynamic state. Patients with disseminated intravascular coagulation have a 21% incidence of NBTE. Although NBTE is usually found at autopsy, premorbid detection by echocardiography is currently possible and feasible. Untreated patients have a high incidence of embolic events, but anticoagulation with heparin may be life-saving. A lethal case of NBTE in a severely injured patient is reported here with the purpose of increasing awareness among medical personnel caring for trauma patients. Recommendations have been made for surveillance echocardiography in high-risk patients, e.g., critically ill patients with sepsis or disseminated intravascular coagulation.
Department of Surgery, Oregon Health Sciences University, Portland 97201-3098, USA.