[Brain abscess in a bidirectional atrial septal defect in adulthood]

An abscess of the brain is a serious complication in patients with congenital heart malformation. The great majority of cases are limited to cyanotic congenital heart disease and a peak in the age distribution can be seen in childhood. We report on a 40-year-old man with progressive right hemiparesis due to an abscess in the left basal ganglia. Clinical aspects and additional diagnostic assessment are described. By cardiologic examination including transoesophageal cross-sectional echocardiography a bidirectional sinus-venosus defect could be detected. This finding supported the diagnosis of a so-called 'paradoxical' brain abscess.