Clinics in diagnostic imaging (51). Multiloculated cerebral abscesses due to paradoxical cardiac emboli

Area of Science:

• Neurology
• Cardiology
• Infectious Diseases

Background:

• Congenital cyanotic heart disease, such as Epstein anomaly and ventricular septal defect, can predispose individuals to paradoxical embolism and subsequent brain abscess formation.
• Persistent headaches and intermittent fever in a patient with known cyanotic heart disease warrant a thorough investigation for intracranial complications.

Observation:

• A 19-year-old female presented with a five-week history of headaches and fever, exhibiting central cyanosis and finger clubbing.
• Cerebral MR imaging revealed characteristic features of multiple brain abscesses in the right frontal lobe, including ring enhancement and specific signal intensities on T1- and T2-weighted images.
• Elevated leukocyte count supported the presence of an infectious process.

Findings:

• Surgical confirmation via craniotomy and pus drainage established the diagnosis of brain abscesses.
• The patient achieved a good clinical outcome following a combined treatment regimen of antibiotics and surgical intervention.
• Follow-up CT scans demonstrated encephalomalacia at the resolved abscess sites, indicating successful healing.

Implications:

• This case underscores the critical role of advanced neuroimaging techniques, particularly MR imaging, in the early and accurate diagnosis of brain abscesses in patients with congenital heart disease.
• Effective management relies on a multidisciplinary approach involving prompt surgical drainage and appropriate antibiotic therapy.
• Understanding the etiology and clinical presentation is crucial for timely intervention and improved patient prognosis.