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An interesting case of cerebral abscess
1Royal Hallamshire Hospital, Neurology, Glossop Road, Sheffield, South Yorkshire, S10 2JF, UK.
BMJ Case Reports
|June 21, 2011
Summary
Hereditary hemorrhagic telangiectasia (HHT) can cause serious neurological complications. This case highlights how HHT-related lung arteriovenous malformations can lead to cerebral abscesses through paradoxical embolism.
Area of Science:
- Neurology
- Cardiology
- Genetics
Background:
- Cerebral abscesses are serious infections requiring prompt diagnosis and treatment.
- Hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder characterized by abnormal blood vessel formation.
- Patients with HHT may present with diverse symptoms, including neurological complications.
Purpose of the Study:
- To present a case of cerebral abscess in a patient with undiagnosed hereditary hemorrhagic telangiectasia (HHT).
- To illustrate the diagnostic challenges and clinical manifestations of HHT-related neurological complications.
- To emphasize the importance of considering HHT in patients with unexplained cyanosis, telangiectasias, and neurological symptoms.
Main Methods:
- Case report of a Romanian immigrant presenting with cerebral abscess.
- Clinical examination including cardiovascular and neurological assessments.
- Diagnostic workup involving imaging to identify arteriovenous malformations (AVMs) and assess for paradoxical embolism.
Main Results:
- The patient presented with cyanosis, finger clubbing, and a systolic murmur, initially suggestive of congenital heart disease.
- A diagnosis of hereditary hemorrhagic telangiectasia (HHT) was made based on epistaxis and telangiectasias.
- Large pulmonary arteriovenous malformations (PAVMs) were identified, explaining the cyanosis via right-to-left shunting and the cerebral abscess via paradoxical septic embolization.
Conclusions:
- Cerebral abscess can be a rare but severe manifestation of hereditary hemorrhagic telangiectasia (HHT).
- Pulmonary arteriovenous malformations in HHT patients pose a risk for paradoxical embolism, leading to conditions like brain abscess.
- Early recognition of HHT and its associated AVMs is crucial for preventing serious complications in affected individuals.
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