Suspicious seizures: Uncommon complication of PFO/ASA

Area of Science:

• Neurology
• Cardiology
• Infectious Diseases

Background:

• Brain abscesses are serious infections, with cardiac causes accounting for 5% of cases.
• Valvular heart disease and endocarditis are common cardiac etiologies.
• Congenital heart disease, particularly with right-to-left shunts, can lead to paradoxical embolization and brain abscess.

Purpose of the Study:

• To report a case of a solitary brain abscess in a young patient with an undiagnosed patent foramen ovale (PFO).
• To investigate the etiology of a brain abscess without an apparent primary source of infection.
• To highlight the potential role of PFO in cryptogenic brain abscesses.

Main Methods:

• Case presentation of a young patient with a solitary brain abscess.
• Infection source investigation using computed tomography (CT) and magnetic resonance imaging (MRI).
• Cardiac evaluation including transesophageal echocardiography (TEE) with bubble study.

Main Results:

• No evidence of contiguous infection spread was found on neuroimaging.
• Hematogenous spread of Streptococcus species was the suspected etiology.
• TEE revealed no valvular endocarditis but confirmed right-to-left shunting through a PFO.

Conclusions:

• Patent foramen ovale (PFO) should be considered in the etiology of brain abscesses of unclear origin.
• Transesophageal echocardiography (TEE) with bubble study is a valuable diagnostic tool for identifying PFO in such cases.
• Screening patients with cryptogenic brain abscesses for PFO is recommended.