Doepp Florian, Schreiber Stephan J, Wandinger Klaus-Peter, Trendelenburg George, Valdueza José M
Department of Neurology, University Hospital Charité, Schumannstr. 20/21, 10117 Berlin, Germany.
Clin Neurol Neurosurg. 2006 Feb;108(2):187-90. 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.
我们报告了一例67岁男性的多发性脑脓肿（BA）病例，该患者出现进行性定向障碍和遗忘性失语症状。症状在肛周脓肿手术治疗一周后出现。未发现其他感染源，脓肿局限于脑部。免疫状态正常，但发现有卵圆孔未闭（pFO）。患者接受了大剂量抗生素治疗，脑脓肿在影像学上完全消失。感染性栓子仅从肛周病灶血行播散至脑部的情况非常罕见。在我们的患者中，感染扩散至脑部的机制可能是通过心脏右向左分流，或者是通过非瓣膜性椎静脉系统。在本手稿中，对这两种途径都进行了批判性综述。
