Document Detail

Patent foramen ovale as a possible risk factor for cryptogenic brain abscess: report of two cases.
MedLine Citation:
PMID:  11440444     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE AND IMPORTANCE: Patent foramen ovale (PFO) has been suggested as a potential source of paradoxical embolism. A higher prevalence of PFO in ischemic stroke of unexplained cause has been recognized. Brain abscesses are commonly associated with a contiguous focus of infection, hematogenous spread from a distant focus, or cranial trauma. However, no predisposing factors, including a distant focus with unknown cause, are identified in approximately 15 to 30% of reported cases. CLINICAL PRESENTATION: We encountered two patients with brain abscess presumably caused by dental infections. Both patients displayed PFO, through which right-to-left atrial contrast shunting was revealed by transesophageal echocardiography. Although the radiological location of the abscesses suggested hematogenous spread as a cause, the patients had no arteriovenous shunting other than the PFO, despite exhaustive investigations for a potential infectious route. The patients displayed no definite focal orofacial inflammatory signs during the postoperative course despite diagnosis of pyorrhea alveolaris or periodontitis. INTERVENTION: In Patient 1, the abscess was aspirated stereotactically, and in Patient 2, the abscess disappeared radiologically after high-dose antibiotic treatment. CONCLUSION: The mechanism of brain abscess formation putatively related to PFO should be different from that related to common dental sepsis. Analysis of these cases suggested that infectious embolism from a latent or even identifiable focus through the PFO may be an underrecognized cause of brain abscess, in contrast to simple seeding of the brain via transit of the infecting bacteria through the valveless emissary veins.
T Kawamata; M Takeshita; N Ishizuka; T Hori
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  49     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2001 Jul 
Date Detail:
Created Date:  2001-07-06     Completed Date:  2001-11-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  204-6; discussion 206-7     Citation Subset:  IM    
Department of Neurosurgery, Tokyo Women's Medical University, Japan.
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MeSH Terms
Anti-Bacterial Agents / therapeutic use
Brain Abscess / diagnosis,  drug therapy,  etiology*,  microbiology,  surgery
Drainage / methods
Echocardiography, Transesophageal
Heart Septal Defects, Atrial / complications*,  diagnosis
Magnetic Resonance Imaging
Middle Aged
Risk Factors
Stereotaxic Techniques
Streptococcal Infections / drug therapy
Suppuration / metabolism
Tomography, X-Ray Computed
Reg. No./Substance:
0/Anti-Bacterial Agents
Comment In:
Neurosurgery. 2002 Mar;50(3):674-5   [PMID:  11890156 ]

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