Table 5. Management of neurologic complications of infective endocarditis.

Guidelines	Recommendation	Level/class of evidence
ESC guidelines	After a silent embolism or transient ischemic attack, cardiac surgery, if indicated, is recommended without delay	I/B
	Following intracranial haemorrhage, surgery should generally be postponed for ≥1 month	IIa/B
	After a stroke, surgery indicated for HF, uncontrolled infection, abscess, or persistent high embolic risk should be considered without any delay as long as coma is absent and the presence of cerebral haemorrhage has been excluded by cranial CT or MRI	IIa/B
AHA/ACC guidelines	Operation without delay may be considered in patients with IE and an indication for surgery who have suffered a stroke but have no evidence of intracranial hemorrhage or extensive neurological damage	IIb/C
	Delaying valve surgery for at least 4 weeks may be considered for patients with IE and major ischemic stroke or intracranial hemorrhage if the patient is hemodynamically stable	IIb/C

In both guidelines, the present of cerebral hemorrhage forces to postpone the surgery and the patient's clinical conditions (both neurological and hemodynamic) play a fundamental role in confirming the indication. The ESC guidelines show more attention to the colonization of other organs by pathogenic organisms. IE, Infective endocarditis; ESC, European Society of Cardiology; AHA, American Heart Association; ACC, American College of Cardiology; HF, heart failure.