Urgent Cardiac Surgery for Endocarditis and Intracranial Hemorrhage Causing Midline Cerebral Shift

Intracranial hemorrhage is a rare and severe complication of infective endocarditis. Current treatment guidelines recommend 4 weeks between intracranial hemorrhage onset and cardiac surgery. However, some exceptions warrant earlier surgical interventions, namely, refractory congestive heart failure and ongoing embolic phenomena. We report a case of mitral valve infective endocarditis complicated by intracranial hemorrhage associated with midline cerebral shift, in which successful early surgical intervention was performed without neurologic complication. This case highlights the importance of careful surgical timing through thorough multidisciplinary discussions to provide optimal clinical outcomes as well as the need for disease registries to share patient care decisions.