Abstract
Brain abscess results from local or metastatic septic spread to the brain. The primary infectious site is often undetected, more commonly so when it is distant. Unlike pediatric congenital heart disease, minor intracardiac right-to-left shunting due to patent foramen ovale has not been appreciated as a cause of brain abscess in adults. Here we present a case of brain abscess associated with a patent foramen ovale in a 53-year old man with dental-gingival sepsis treated in the intensive care unit. Based on this case and the relevant literature we suggest a link between a silent patent foramen ovale, paradoxic pathogen dissemination to the brain, and development of brain abscess.
Highlights
One of the functions of the lung vasculature is to mechanically filter the blood; right-to-left circulatory shunts can serve as entrance gates for bland or septic thrombi into the arterial circulation [1,2,3]
Pediatric brain abscess secondary to paradoxic infection via congenital intracardiac shunts, as well as adult brain abscess resulting from extracardiac shunts, such as pulmonary arteriovenous malformation (PAVM), are well recognized [4,5,6]
AFig5u3-ryeea1r-old man with reported seizures was evaluated A 53-year-old man with reported seizures was evaluated. (A) Head computed tomography (CT) without contrast medium reveals a round left occipital mass lesion with hyperdense margins and a hypodense center. (B) A T-2-weighted head magnetic resonance imaging (MRI) image without contrast shows a mass with high central signal intensity, a ring of heterogeneous peripheral signal intensity similar to that of the brain parenchyma, and a surrounding area of bright signal in the white-matter tracts. (C) On the contrast-enhanced T-1weighted head MRI image, the mass has low signal intensity centrally that suggests the presence of fluid, and is surrounded by an enhancement ring, beyond which extends an area of low signal that indicates edema
Summary
One of the functions of the lung vasculature is to mechanically filter the blood; right-to-left circulatory shunts can serve as entrance gates for bland or septic thrombi into the arterial circulation [1,2,3]. A 53-yr-old farmer presented 8 days after having suffered a seizure He reported another seizure 2 months before, for which he did not seek medical attention. His past history included morbid obesity (body mass index: 51.5), a right bundle branch block, heavy nicotine addiction (65 pack-years; Fagerstrom test score = 8), chronic obstructive pulmonary disease (COPD), and trigeminal neuralgia for the last ten years. His dental health was impaired with dental, periodontal, and gingival sepsis and a recent history of dental procedures, for which he did not take antibiotics. After two years of follow-up he has recovered almost completely, still showing residual lower limb weakness
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