Screening in cryptogenic brain abscess: Do not forget pulmonary arteriovenous malformations

Area of Science:

• Neurology
• Cardiology
• Radiology

Background:

• Brain abscesses typically arise from trauma, contiguous spread, or neurosurgery.
• Hematogenous spread via arteriovenous (AV) shunts is a less common cause.
• Pulmonary arteriovenous malformations (PAVMs) are an uncommon cause of AV shunts facilitating brain abscess.

Observation:

• A 74-year-old male presented with neurological deficits and symptoms of infection.
• A brain abscess in the left occipital lobe was diagnosed.
• A solitary PAVM in the left lung was identified during diagnostic workup.

Findings:

• The brain abscess was successfully treated with surgical resection.
• The PAVM was subsequently treated with endovascular embolization.
• No other underlying pathology was identified.

Implications:

• Chest CT with IV contrast should be considered for screening PAVMs in brain abscess patients.
• Identifying and treating PAVMs can prevent recurrent or secondary brain abscesses.
• This case highlights the importance of considering rare causes of brain abscess.