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Nonbacterial Thrombotic Endocarditis: A Neurologic Perspective of Clinicopathologic Correlations of 99 Patients

Nonbacterial Thrombotic Endocarditis: A Neurologic Perspective of Clinicopathologic Correlations... Abstract • Of 13,913 patients examined at autopsy between 1939 and 1980, the diagnosis of nonbacterial thrombotic endocarditis (NBTE) was made in 99 instances. There were 53 males and 46 females ranging in age from 4 to 89 years. Vegetations were found on the aortic valve in 39; the mitral in 37; the tricuspid in nine; and the pulmonic in two. Two-valve involvement was present in 12 cases. Malignant neoplasms were found in 42 autopsies. Embolism to the brain was found in 33 cases and to other organs in 62. Coagulation abnormalities were documented in 22 cases, and a distinct picture of disseminated intravascular coagulation was found in ten cases. The presence of thrombophlebitis elsewhere in the body should arouse suspicion of NBTE. The high incidence of multiple emboli and its association with malignant neoplasms and with a variety of cardiovascular, pulmonary, renal, and gastrointestinal disorders should provide clues for recognition of this serious disorder. References 1. MacDonald RA, Robbins SL: The significance of nonbacterial thrombotic endocarditis: An autopsy and clinical study of 78 cases . Ann Intern Med 1957;46:255-273.Crossref 2. Barron KD, Siqueira E, Hirano A: Cerebral embolism caused by nonbacterial thrombotic endocarditis . Neurology 1960;10:391-397.Crossref 3. Aguayo AJ: Cerebral thrombo-embolism in malignancy . Arch Neurol 1964;11:500-506.Crossref 4. Bryan CHS: Nonbacterial thrombotic endocarditis with malignant tumors . Am J Med 1969;46:787-793.Crossref 5. Chaudhurri MR: Nonbacterial thrombotic endocarditis in association with mucus secreting adenocarcinomas . Br J Dis Chest 1971;65:98-104.Crossref 6. Rosen P, Armstrong D: Nonbacterial thrombotic endocarditis in patients with malignant neoplastic disease . Am J Med 1973;54:23-29.Crossref 7. Reagan TJ, Okazaki H: The thrombotic syndrome associated with carcinoma: A clinical and neuropathologic study . Arch Neurol 1974;31:390-395.Crossref 8. Chino F, Kodama A, Otake M, et al: Nonbacterial thrombotic endocarditis in a Japanese autopsy sample: A review of 80 cases . Am Heart J 1975;90:190-198.Crossref 9. Delgado G, Smith JP: Gynecological malignancy associated with nonbacterial thrombotic endocarditis (NBTE) . Gynecol Oncol 1975;3:205-209.Crossref 10. Deppisch LM, Fayemi AO: Non-bacterial thrombotic endocarditis: Clinico-pathologic correlation . Am Heart J 1976;92:723-729.Crossref 11. Tsanaclis AMC, Robert F: Cerebral embolism in nonbacterial thrombotic endocarditis associated with carcinoma: A clinico-pathological study . Acta Neurol Lat Am 1976;22:86-103. 12. Kooiker JC, MacLean JM, Sumi SM: Cerebral embolism, marantic endocarditis, and cancer . Arch Neurol 1976;33:260-264.Crossref 13. Miale JB: Diffuse intravascular coagulation , in: Laboratory Medicine: Hematology , ed 5. St Louis, CV Mosby Co, 1977, pp 965-971. 14. Horwitz CA, Ward PCJ: Disseminated intravascular coagulation, nonbacterial thrombotic endocarditis and adult pulmonary hyaline membranes: An interrelated triad? Am J Med 1971;51:272-280.Crossref 15. Remillard GM, Carpenter S: Cerebral embolism due to non-bacterial thrombotic endocarditis . Can Med Assoc J 1972;106:573-576. 16. Vilanova JR, Norenberg MD, Stuard ID: Thrombotic thrombocytopenic purpura: Systemic embolization from nonbacterial thrombotic endocarditis . NY State J Med 1975;75:2246-2248. 17. Lindstrom FD, Flodmark O, Gustafson B: Respiratory distress syndrome and thrombotic, non-bacterial endocarditis after amitryptyline overdose . Acta Med Scand 1977;202:203-212.Crossref 18. Case 41491, Case records of the Massachusetts General Hospital . N Engl J Med 1955;253:1030-1036.Crossref 19. Oppenheimer EH, Esterly JR: Nonbacterial thrombotic vegetations: Occurrence in neonate, infant and child, and relation to valvular lesions in cardiac defects . Am J Pathol 1968;53:63-73. 20. Krous HF: Neonatal nonbacterial thrombotic endocarditis . Arch Pathol Lab Med 1979;103:76-78. 21. Fayemi AO, Deppisch LM: Coronary embolism and myocardial infarction associated with nonbacterial thrombotic endocarditis . Am J Clin Pathol 1977;68:393-396. 22. Fayemi AO, Deppisch LM: Nonbacterial thrombotic endocarditis and myocardial infarction . Am Heart J 1979;97:405-406.Crossref 23. Minna JD, Robboy S, Coluder RW: Disseminated Intravascular Coagulation in Man . Springfield, Ill. Charles C Thomas Publisher, 1974. 24. Dillon JC, Feigenbaum H, Konecke LL, et al: Echocardiographic manifestations of valvular vegetations . Am Heart J 1973;86:698-704.Crossref 25. Estevez CM, Corya BC: Serial echocardiographic abnormalities in non-bacterial thrombotic endocarditis of the mitral valve . Chest 1976;69:801-804.Crossref 26. Easton JD, Sherman DG: Management of cerebral embolism of cardiac origin . Stroke 1980;11:433-442.Crossref 27. Waller BF, Knapp WS, Edwards JE: Marantic valvular vegetations . Circulation 1973;48:644-650.Crossref 28. Cannady PB, Sanford JP: Negative blood cultures in infective endocarditis: A review . South Med J 1976;69:1420-1424.Crossref 29. Wooley CF, Baba N, Ryan JM: Nonbacterial thrombotic endocarditis. Clinical recognition . Arch Intern Med 1970;125:126-128.Crossref 30. Guinn GA, Ayala A, Liddicoat J: Clinical and therapeutic considerations in nonbacterial thrombotic endocarditis . Chest 1973;64:26-28.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Nonbacterial Thrombotic Endocarditis: A Neurologic Perspective of Clinicopathologic Correlations of 99 Patients

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1982.00510140029007
Publisher site
See Article on Publisher Site

Abstract

Abstract • Of 13,913 patients examined at autopsy between 1939 and 1980, the diagnosis of nonbacterial thrombotic endocarditis (NBTE) was made in 99 instances. There were 53 males and 46 females ranging in age from 4 to 89 years. Vegetations were found on the aortic valve in 39; the mitral in 37; the tricuspid in nine; and the pulmonic in two. Two-valve involvement was present in 12 cases. Malignant neoplasms were found in 42 autopsies. Embolism to the brain was found in 33 cases and to other organs in 62. Coagulation abnormalities were documented in 22 cases, and a distinct picture of disseminated intravascular coagulation was found in ten cases. The presence of thrombophlebitis elsewhere in the body should arouse suspicion of NBTE. The high incidence of multiple emboli and its association with malignant neoplasms and with a variety of cardiovascular, pulmonary, renal, and gastrointestinal disorders should provide clues for recognition of this serious disorder. References 1. MacDonald RA, Robbins SL: The significance of nonbacterial thrombotic endocarditis: An autopsy and clinical study of 78 cases . Ann Intern Med 1957;46:255-273.Crossref 2. Barron KD, Siqueira E, Hirano A: Cerebral embolism caused by nonbacterial thrombotic endocarditis . Neurology 1960;10:391-397.Crossref 3. Aguayo AJ: Cerebral thrombo-embolism in malignancy . Arch Neurol 1964;11:500-506.Crossref 4. Bryan CHS: Nonbacterial thrombotic endocarditis with malignant tumors . Am J Med 1969;46:787-793.Crossref 5. Chaudhurri MR: Nonbacterial thrombotic endocarditis in association with mucus secreting adenocarcinomas . Br J Dis Chest 1971;65:98-104.Crossref 6. Rosen P, Armstrong D: Nonbacterial thrombotic endocarditis in patients with malignant neoplastic disease . Am J Med 1973;54:23-29.Crossref 7. Reagan TJ, Okazaki H: The thrombotic syndrome associated with carcinoma: A clinical and neuropathologic study . Arch Neurol 1974;31:390-395.Crossref 8. Chino F, Kodama A, Otake M, et al: Nonbacterial thrombotic endocarditis in a Japanese autopsy sample: A review of 80 cases . Am Heart J 1975;90:190-198.Crossref 9. Delgado G, Smith JP: Gynecological malignancy associated with nonbacterial thrombotic endocarditis (NBTE) . Gynecol Oncol 1975;3:205-209.Crossref 10. Deppisch LM, Fayemi AO: Non-bacterial thrombotic endocarditis: Clinico-pathologic correlation . Am Heart J 1976;92:723-729.Crossref 11. Tsanaclis AMC, Robert F: Cerebral embolism in nonbacterial thrombotic endocarditis associated with carcinoma: A clinico-pathological study . Acta Neurol Lat Am 1976;22:86-103. 12. Kooiker JC, MacLean JM, Sumi SM: Cerebral embolism, marantic endocarditis, and cancer . Arch Neurol 1976;33:260-264.Crossref 13. Miale JB: Diffuse intravascular coagulation , in: Laboratory Medicine: Hematology , ed 5. St Louis, CV Mosby Co, 1977, pp 965-971. 14. Horwitz CA, Ward PCJ: Disseminated intravascular coagulation, nonbacterial thrombotic endocarditis and adult pulmonary hyaline membranes: An interrelated triad? Am J Med 1971;51:272-280.Crossref 15. Remillard GM, Carpenter S: Cerebral embolism due to non-bacterial thrombotic endocarditis . Can Med Assoc J 1972;106:573-576. 16. Vilanova JR, Norenberg MD, Stuard ID: Thrombotic thrombocytopenic purpura: Systemic embolization from nonbacterial thrombotic endocarditis . NY State J Med 1975;75:2246-2248. 17. Lindstrom FD, Flodmark O, Gustafson B: Respiratory distress syndrome and thrombotic, non-bacterial endocarditis after amitryptyline overdose . Acta Med Scand 1977;202:203-212.Crossref 18. Case 41491, Case records of the Massachusetts General Hospital . N Engl J Med 1955;253:1030-1036.Crossref 19. Oppenheimer EH, Esterly JR: Nonbacterial thrombotic vegetations: Occurrence in neonate, infant and child, and relation to valvular lesions in cardiac defects . Am J Pathol 1968;53:63-73. 20. Krous HF: Neonatal nonbacterial thrombotic endocarditis . Arch Pathol Lab Med 1979;103:76-78. 21. Fayemi AO, Deppisch LM: Coronary embolism and myocardial infarction associated with nonbacterial thrombotic endocarditis . Am J Clin Pathol 1977;68:393-396. 22. Fayemi AO, Deppisch LM: Nonbacterial thrombotic endocarditis and myocardial infarction . Am Heart J 1979;97:405-406.Crossref 23. Minna JD, Robboy S, Coluder RW: Disseminated Intravascular Coagulation in Man . Springfield, Ill. Charles C Thomas Publisher, 1974. 24. Dillon JC, Feigenbaum H, Konecke LL, et al: Echocardiographic manifestations of valvular vegetations . Am Heart J 1973;86:698-704.Crossref 25. Estevez CM, Corya BC: Serial echocardiographic abnormalities in non-bacterial thrombotic endocarditis of the mitral valve . Chest 1976;69:801-804.Crossref 26. Easton JD, Sherman DG: Management of cerebral embolism of cardiac origin . Stroke 1980;11:433-442.Crossref 27. Waller BF, Knapp WS, Edwards JE: Marantic valvular vegetations . Circulation 1973;48:644-650.Crossref 28. Cannady PB, Sanford JP: Negative blood cultures in infective endocarditis: A review . South Med J 1976;69:1420-1424.Crossref 29. Wooley CF, Baba N, Ryan JM: Nonbacterial thrombotic endocarditis. Clinical recognition . Arch Intern Med 1970;125:126-128.Crossref 30. Guinn GA, Ayala A, Liddicoat J: Clinical and therapeutic considerations in nonbacterial thrombotic endocarditis . Chest 1973;64:26-28.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Feb 1, 1982

References

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