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. 2009 Nov 25:3:9299.
doi: 10.1186/1752-1947-3-9299.

Brain abscesses in a patient with a patent foramen ovale: a case report

Fuad Jan  1 , Abdul Moiz Hafiz, Saurabh Gupta, John Meidl, Suhail Allaqaband
Affiliations

Brain abscesses in a patient with a patent foramen ovale: a case report

Fuad Jan et al. J Med Case Rep. .

Abstract

Introduction: Brain abscesses arising from right-to-left cardiac shunting are very rare in adults.

Case presentation: We describe the case of a 47-year-old non-hispanic white male with periodontal disease who developed several brain abscesses caused by Streptococcus intermedius. A comprehensive workup revealed a patent foramen ovale with oral flora as the only plausible explanation for the brain abscesses.

Conclusion: Based on this case and the relevant literature, we suggest an association between a silent patent foramen ovale, paradoxical microbial dissemination to the brain, and the development of brain abscesses.

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Figures

Figure 1
Figure 1
Magnetic resonance imaging of the brain. (A) T1-weighted images at the patient's presentation, post-contrast showing multiple ring enhancing lesions in the brain (white arrow heads). (B) T1-weighted images eight months after treatment showing a resolution of the brain abscesses.
Figure 2
Figure 2
Transesophageal echocardiography during the patient's initial hospitalization. (A) A bidirectional interatrial shunt seen through the patent foramen ovale. RA, right atrium; LA, left atrium. (B) Injection of agitated saline through an upper extremity peripheral vein showing the appearance of bubbles crossing from the right to the left atrium. RA, right atrium; LA, left atrium.
See this image and copyright information in PMC

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