Walsh Katie, Kaliaperumal Chandrasekaran, Wyse Gerry, Kaar George
Department of Neurosurgery, Cork University Hospital, Cork, Ireland.
BMJ Case Rep. 2011 Jul 20;2011:bcr0620114305. doi: 10.1136/bcr.06.2011.4305.
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.
我们描述了一例患有先天性心脏缺陷的53岁女性脑脓肿病例。她患有房间隔缺损合并房间隔瘤，直至此次临床表现才被诊断出来。她因右侧偏瘫病史较短前来就诊，神经影像学检查显示左额顶叶区域有一个不均匀的病灶。在神经导航引导下进行了左额顶叶开颅手术以切除病灶，术前引流出了明显的脓液，培养结果为星座链球菌。她接受了6周的抗生素治疗并成功治愈，临床状况有所改善。我们认为患者之前的拔牙可能导致了反常栓塞，栓子通过房间隔缺损绕过肺循环。磁共振成像扫描结果具有误导性，因为最初认为是高级别脑肿瘤。
