title: Multiple brain abscesses following surgical treatment of a perianal abscess.
abstract: 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.
authors.affiliation: Department of Neurology, University Hospital Charité, Schumannstr. 20/21, 10117 Berlin, Germany. florian.doepp@charite.de
authors.forename: Florian
authors.initials: F
authors.lastname: Doepp
authors.forename: Stephan J
authors.initials: SJ
authors.lastname: Schreiber
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Wandinger
authors.forename: George
authors.initials: G
authors.lastname: Trendelenburg
authors.forename: José M
authors.initials: JM
authors.lastname: Valdueza
mesh_terms: D000368:Aged; D001004:Anus Diseases / Q000601:surgery*; D001921:Brain / Q000098:blood supply; D001922:Brain Abscess / Q000209:etiology*; D004927:Escherichia coli Infections / Q000209:etiology*; D006344:Heart Septal Defects, Atrial / Q000150:complications; D006801:Humans; D008297:Male; D010388:Pelvis / Q000098:blood supply; D014680:Veins