Brain abscess associated with patent foramen ovale

Sadahiro, Hirokazu; Nomura, Sadahiro; Inamura, Akinori; Yamane, Akiko; Sugimoto, Kazutaka; Fujiyama, Yuichi; Suzuki, Michiyasu

doi:10.1007/s00701-014-2170-1

Cited by 12 publications

(17 citation statements)

References 35 publications

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“…Interestingly, the brain region affected most in CBA cases with a PFO was the posterior circulation area (57.2% in posterior region); whereas general brain abscesses predominantly affected the anterior area (78% in anterior region). Approximately one-third of CBA cases, including ours, resulted in neurological disability [3] [13] or death [7] [11]; however, most patients with general abscesses had good recovery (81.3%) [2].…”

Section: Discussionmentioning

confidence: 68%

“…There have been 21 similar cases of CBA accompanied by PFO reported to date [3]- [15]. To clarify the clinical features of these patients, we compared cases of CBA accompanied by PFO with general cases reported by Nathoo et al [2].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, previous reports have speculated that brain abscess formation in PFO cases depends on the magnitude of the right-to-left shunt [7]. PFO size was specified in 12 of the 21 cases reported [ [3]. They defined large PFO as 26 or more contrast bubbles within three cardiac cycles during TEE.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have reported septal occlusion as an excellent method for reducing the risk of brain abscesses [8] [10] [15]; however, no large studies have evaluated the efficacy of PFO disclosure in preventing recurrence of brain abscesses. Other shave suggested maintenance of oral hygiene for preventing brain abscess recurrence given that majority of patients with PFO had dental diseases [3]. Consequently, we did not perform disclosure of PFO, but maintained oral hygiene to prevent CBA recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…However, in about 4% of cases, the primary source of infection remains unknown, thus known as cryptogenic brain abscesses (CBA) [2]. Some of these patients present with a patent foramen ovale (PFO) or pulmonary arteriovenous fistula, possibly allowing bacteria to bypass pulmonary circulation through a shunt [3]. Here we describe a patient with a spontaneous right-to-left shunt through the PFO, who subsequently developed a brain abscess.…”

Section: Introductionmentioning

confidence: 98%

See 4 more Smart Citations

Clinical and Radiological Features in the Cases with Cryptogenic Brain Abscess in Association with Patent Foramen Ovale: A Case Report and Review of the Literature

Sugie¹,

Jimi²,

Kashimura³

et al. 2014

IJCM

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Brain abscesses are commonly associated with cranial trauma, a contiguous focus of infection, or hematogenous spread from a distant focus. However, no predisposing factors are identified in approximately 4% of the cases, being recognized as a cryptogenic brain abscess (CBA). Here we report a patient with a CBA in the left occipital lobe presumably caused by a periodontal disease. The patient displayed a patent foramen ovale (PFO), through which a spontaneous right-to-left shunt was revealed with transesophageal echocardiography. A literature review indicated that in contrast to cases of general brain abscesses, patients with CBA were older and mostly had dental disorders represented by periodontal diseases and a large PFO. In these patients, the abscess was located predominantly in the posterior circulation area, and their prognosis was worse than that of general cases. Consequently, we emphasize the significance of screening for PFO in cases of advanced age with CBA in the posterior circulation region. Furthermore, to avoid neurological sequelae, we suggest immediate surgical drainage with antibiotic administration and maintenance of oral hygiene.

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