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Brain abscesses associated with pulmonary arteriovenous malformations
H L Brydon1, J Akinwunmi, R Selway
1Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK.
Abstract:
We present three patients with brain abscesses who also had pulmonary arteriovenous malformations (AVMs). All patients had hereditary haemorrhagic telangiectasia (Osler's Disease). It is probable that the lung AVMs contributed to the development of the brain abscesses by allowing bacteria easier access to the systemic circulation through a right to left pulmonary vascular shunt, bypassing the filtering action of the pulmonary capillaries. In addition, one patient required a period of postoperative ventilation using PEEP, which may have exacerbated the shunt through the lung AVM and led to difficulty in weaning her from the ventilator.
Insights
Hereditary haemorrhagic telangiectasia patients with lung arteriovenous malformations (AVMs) may develop brain abscesses. Lung AVMs can allow bacteria to bypass pulmonary filters, increasing infection risk.
Area of Science:
- Neurology
- Cardiology
- Genetics
Background:
- Hereditary haemorrhagic telangiectasia (HHT), also known as Osler's Disease, is a genetic disorder.
- Pulmonary arteriovenous malformations (AVMs) are abnormal connections between pulmonary arteries and veins.
- Brain abscesses are collections of pus within the brain parenchyma.
Observation:
- Three patients with HHT and pulmonary AVMs presented with brain abscesses.
- The presence of lung AVMs in these patients suggests a potential link to brain abscess formation.
Findings:
- Pulmonary AVMs likely facilitated bacterial entry into the systemic circulation by creating a right-to-left shunt.
- This shunt bypasses the natural filtering capacity of pulmonary capillaries, increasing the risk of systemic infections like brain abscesses.
- Positive end-expiratory pressure (PEEP) ventilation in one patient may have worsened the shunt, complicating ventilator weaning.
Implications:
- Early screening for pulmonary AVMs in HHT patients may be warranted to prevent serious complications.
- Understanding the pathophysiology of brain abscesses in HHT patients can guide preventative strategies and treatment.
- This case series highlights the importance of considering vascular anomalies in the etiology of brain abscesses, particularly in patients with genetic conditions like HHT.