Multiple brain abscesses following surgical treatment of a perianal abscess

• Published in: Clinical neurology and neurosurgery 2006-02, Vol.108 (2), p.187-190
• Main Authors: Doepp, Florian, Schreiber, Stephan J., Wandinger, Klaus-Peter, Trendelenburg, George, Valdueza, José M.
• Format: Article
• Language: English
• Subjects: Abdomen; Aged; Anus Diseases - surgery; Biological and medical sciences; Brain - blood supply; Brain abscess; Brain Abscess - etiology; Cardiac right-to-left shunt; Cardiovascular disease; Ear diseases; Escherichia coli Infections - etiology; Heart Septal Defects, Atrial - complications; Humans; Male; Medical imaging; Medical sciences; Neurosurgery; Pelvis - blood supply; Perianal abscess; Sinuses; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Veins; Veins & arteries; Vertebral venous system
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2004.11.024

We report a case of multiple brain abscesses (BAs) in a 67-year-old man with symptoms of progredient disorientation and amnestic aphasia. Onset of symptoms occurred one week after surgical treatment of a perianal abscess. No other source of infection was identified and the abscesses were limited to the brain. The immune status was normal but a patent foramen ovale (pFO) was found. The patient was treated with high-dose antibiotics, leading to a complete radiological disappearance of the BAs. Hematogenous spread of infectious emboli from a perianal focus exclusively to the brain is very rare. In our patient, the mechanisms of infectious spread into the brain might have occurred via a cardiac right-to-left shunt or alternatively via the non-valvular vertebral venous system. In this manuscript, both pathways are critically reviewed.