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Background Cerebral angiography remains the gold standard for the detection of mycotic aneurysms, and it has been estimated that ruptured mycotic aneurysms result in 5% of the neurological complications of patients with infective endocarditis (IE). Objective To determine the diagnostic yield of cerebral angiography in the above patient population and to assess patient factors that might suggest greater or lesser utility. Methods We retrospectively reviewed 168 patients who underwent cerebral angiography with a diagnosis of IE or infected left ventricular assist device at the Cleveland Clinic between January 2003 and March 2010 in accordance with institutional review board guidelines. Chart and imaging review was performed. Results 15/168 patients (8.9%) had mycotic aneurysms; 93.3% (14/15) of the patients with mycotic aneurysms presented with CNS hemorrhage and 66.7% (10/15) had acute ischemic findings. Of the 15 patients with mycotic aneurysms on angiography, seven underwent CT angiography and six underwent MR angiography, which showed mycotic aneurysms in three (42.9%) and two cases (one of which was questionable; 33.3%), respectively. Conclusions Patients with IE or similar sources of central bacterial emboli are prone to neurovascular complications. Approximately 9% of patients with IE at our institution who undergo cerebral angiography have mycotic aneurysms. Presentation with hemorrhage appears to be more predictive of aneurysm, as approximately 22% of patients with IE and hemorrhage were found to have an aneurysm compared with only 1% when hemorrhage was absent. Thus, patients with IE presenting with intracranial hemorrhage should undergo vascular imaging, preferably with cerebral angiography. [ABSTRACT FROM AUTHOR]

Background There is heterogeneity in the severity of domains affected in patients with stroke, resulting in differences in health-related quality of life (hrQoL). Identifying different clinical profiles of stroke patients may provide a means for selecting patients for tailored interventions to improve hrQoL. Methods and Results This was an observational study of 496 patients with ischemic stroke or intracerebral hemorrhage seen in a cerebrovascular clinic from October 12, 2015, through June 11, 2018, who completed patient-reported outcome measures using Patient-Reported Outcome Measurement Information System (PROMIS) tools within 1 month of stroke. Latent profile analysis identified groups based on PROMIS domain scores-pain, depression, cognitive function, fatigue, social role satisfaction, and physical function-as well as clinician-reported modified Rankin Scale ( mRS ). Five distinct profiles were identified. Group 1 ("excellent hrQoL," n=106) had fewer symptoms in all domains than the general population. Group 2 ("disabled with mixed hrQoL," n=17) had fewer symptoms than the general population in all domains except social role satisfaction and physical function, despite having moderate disability (median mRS score: 3). Group 3 ("mild limitations with average hrQoL," n=189) had scores similar to the general population for all domains and minimal disability (median mRS score: 1). Group 4 ("mild limitations with poor hrQoL," n=152) also had a median mRS score of 1 but had worse scores than group 3 on all domains. Group 5 ("disabled with poor hrQoL," n=32) had worse symptoms than patients in the other profiles and a median mRS score of 3. Conclusions Patients with recent stroke have distinct clinical symptom profiles, even with similar levels of clinician-reported disability. Symptom profiles provide a means of understanding patterns of outcomes in patients with stroke.