Brain Abscess Revealing an Undiagnosed Atrioventricular Septal Defect With a Common Atrium in a Young Adult

Area of Science:

• Neurology
• Cardiology
• Infectious Diseases

Background:

• Brain abscess is a rare but severe intracranial infection, often from contiguous spread or hematogenous dissemination.
• Congenital heart disease, particularly defects allowing right-to-left shunting, can predispose to brain abscesses.
• Atrioventricular septal defect (AVSD) with a common atrium is an uncommon cause, rarely presenting as the initial adult manifestation.

Purpose of the Study:

• To report a rare case of brain abscess as the initial presentation of an undiagnosed atrioventricular septal defect (AVSD) with a common atrium in an adult.
• To highlight the diagnostic challenges and the importance of cardiovascular assessment in brain abscess cases.
• To emphasize the potential for intracardiac defects to facilitate septic emboli bypassing pulmonary circulation.

Main Methods:

• Case report of an 18-year-old male presenting with seizure and headache.
• Neuroimaging confirmed a right frontal lobe abscess.
• Cardiac evaluation revealed atrial flutter and an undiagnosed AVSD with a common atrium.

Main Results:

• The patient presented with symptoms suggestive of brain abscess, later found to have an undiagnosed AVSD.
• Successful treatment involved surgical drainage of the abscess and medical management.
• Full radiological resolution and clinical stability were achieved at 6-month follow-up.

Conclusions:

• Brain abscess can be the initial manifestation of AVSD with a common atrium, especially when atrial septation is absent.
• The defect allows mixing of blood and potential bypass of pulmonary clearance for septic emboli.
• Thorough cardiovascular examination and echocardiography are vital for patients with unexplained brain abscesses.