Streptococcus oralis as a risk factor for middle cerebral artery thrombosis

We reported a case of an 8-year-old boy who was presented to the emergency department with left-sided hemiparesis. Computed tomography showed hypodense areas in the territory of the right middle cerebral artery, indicating acute cerebral infarct. Diagnostic evaluation was performed to identify the etiology. On the eighteenth day of hospitalization, cerebrospinal fluid cultures yielded Streptococcus oralis. We hypothesized that the source of the oral pathogen was an abscess belonging to his upper left fourth tooth, which, by a transient bacteremia, had invaded the central nervous system, and skipping the meninges caused local inflammatory arteritis of the carotid artery, leading to cerebral infarction. Sulbactam-ampicillin therapy was initiated for 14 days, and he was discharged with anticoagulation therapy.