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Brain abscess associated with patent foramen ovale

  • Clinical Article - Conference Report
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Abstract

Background

Brain abscesses can develop with Tetralogy of Fallot and pulmonary anterior venous fistula with large right-to-left shunt. However, some patients exhibit cryptogenic brain abscess (CBA) in the absence of any such congenital disease or other infections. Patent foramen ovale (PFO) is a very common disease that exhibits right-to-left shunt. This study reports the potential for concern between CBA and PFO.

Methods

We enrolled patients with CBA in our hospital between January 2003 and January 2013. Patients underwent transesophageal echocardiography (TEE) with contrast medium to investigate the presence of PFO.

Results

Seven patients were included. Four were females, and the mean age was 67.7 ± 9.2 years. In all patients, TEE failed to reveal any new findings, however, six patients had PFO, and another patient had pulmonary arteriovenous shunt. Four patients had odontopathy.

Conclusion

In this study, all CBA patients exhibited right-to-left shunt. CBA might be caused by paradoxical embolization of a bacterial mass via PFO. Thus, more patients with CBA need to undergo TEE to detect PFO.

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Conflicts of interest

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Authors and Affiliations

  1. Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, Japan

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

Authors
  1. Hirokazu Sadahiro
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  2. Sadahiro Nomura
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  3. Akinori Inamura
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  4. Akiko Yamane
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  5. Kazutaka Sugimoto
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  6. Yuichi Fujiyama
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  7. Michiyasu Suzuki
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Corresponding author

Correspondence to Hirokazu Sadahiro.

Additional information

Comment

About half of all brain abscesses are considered to be of hematogenous origin. Consequently, echocardiography and pulmonary evaluation are routinely used to evaluate a possible source of the infection.

Patent foramen ovale (PFO) has not been considered an important source of brain abscesses. It is a common condition (approximately 25 % of adults) and requires contrast TEE to be reliably detected.

The authors have collected a series of seven cases of cryptogenic brain abscesses in which six of the patients exhibited a PFO on TEE. Four of the six patients also had dental disease. Similarly to the situation of cryptogenic stroke where the contribution of a PFO is still under debate, the authors have not proven a correlation, but have highlighted a possible etiological mechanism that has received little attention in the literature.

Zvi Harry Rappaport

Petah Tiqva, Israel

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Sadahiro, H., Nomura, S., Inamura, A. et al. Brain abscess associated with patent foramen ovale. Acta Neurochir 156, 1971–1976 (2014). https://doi.org/10.1007/s00701-014-2170-1

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  • DOI: https://doi.org/10.1007/s00701-014-2170-1

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