Multiple cerebral septic emboli sourcing from a ventricular assist device: a case report

BACKGROUND: Patients carrying portable cardiac devices are at high risk of serious infections, such as endocarditis and sepsis. The event of a neurological complication should be taken into account, despite the fact that this group of patients is as a rule, strictly anticoagulated and monitored duly. CASE DESCRIPTION: We present the case of a patient of middle age with heart failure awaiting for organ transplantation, and meanwhile having a ventricular assist device (VAD) implanted. The suspicion of an infection was raised following a purulent drainage from the external lead of the device, as well as the clinical picture of malaise, fever and sweating. A right hemiparesis complicated the condition and the brain computerized tomography (CT) scan demonstrated the presence of several hemorrhagic lesions. The suspicion of septic emboli was proven following the result of hemoculture yielding Staphylococcus epidermidis. CONCLUSIONS: The patient was treated with antibiotics, anti-seizure drugs and with supportive therapy, with good recovery of the clinical picture. He was transferred to a cardiac surgery facility for a revision, or eventually for a replacement of the VAD. There is clearly a need for an increased awareness of probable neurological events among patients holding external heart devices. Available guidelines for their follow-up and monitoring should be strictly respected, in order to avoid complications, and eventually install a prompt and adequate treatment.