A neurosurgical presentation of patent foramen ovale with atrial septal aneurysm.
We describe a case of cerebral abscess in a 53-year-old lady with a background of congenital heart defect. She has an atrial septal defect with atrial septal aneurysm, which remained undiagnosed until this clinical presentation. She presented with a short history of right-sided hemiplaegia and neuroimaging revealed a heterogeneous lesion in the left frontoparietal region. Neuronavigation-guided left frontoparietal craniotomy was performed to debulk the lesion and preoperatively frank pus was drained, which grew Streptococcus constellatus. She was successfully treated with antibiotics for 6 weeks and her clinical condition improved. We believe that the patients' previous dental extraction has possibly resulted in a paradoxical embolism through the atrial septal defect bypassing the pulmonary circulation. The MRI scan picture was misleading, as it was initially thought to be a high-grade brain tumour.
Department of Neurosurgery, Cork University Hospital, Cork, Ireland.
Katie
K
Walsh
Chandrasekaran
C
Kaliaperumal
Gerry
G
Wyse
George
G
Kaar
D054087:Atrial Septum; D001922:Brain Abscess / Q000150:complications* / Q000601:surgery; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications*; D006322:Heart Aneurysm / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D013290:Streptococcal Infections / Q000150:complications* / Q000601:surgery; D034365:Streptococcus constellatus