Journal of Korean Neurosurgical Society

  • 제60권1호
  • /
  • Pages.118-124
  • /
  • 2017
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지
DOI QR코드

DOI QR Code

Brain Abscesses Associated with Asymptomatic Pulmonary Arteriovenous Fistulas

  • Nam, Taek-Kyun (Department of Neurosurgery, Chung-Ang University College of Medicine) ;
  • Park, Yong-sook (Department of Neurosurgery, Chung-Ang University College of Medicine) ;
  • Kwon, Jeong-taik (Department of Neurosurgery, Chung-Ang University College of Medicine)
  • 투고 : 2015.07.14
  • 심사 : 2016.02.05
  • 발행 : 2017.01.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Brain abscess commonly occurs secondary to an adjacent infection (mostly in the middle ear or paranasal sinuses) or due to hematogenous spread from a distant infection or trauma. Pulmonary arteriovenous fistulas (AVFs) are abnormal direct communications between the pulmonary artery and vein. We present two cases of brain abscess associated with asymptomatic pulmonary AVF. A 65-year-old woman was admitted with a headache and cognitive impairment that aggravated 10 days prior. An magnetic resonance (MR) imaging revealed a brain abscess with severe edema in the right frontal lobe. We performed a craniotomy and abscess removal. Bacteriological culture proved negative. Her chest computed tomography (CT) showed multiple AVFs. Therapeutic embolization of multiple pulmonary AVFs was performed and antibiotics were administered for 8 weeks. A 45-year-old woman presented with a 7-day history of progressive left hemiparesis. She had no remarkable past medical history or family history. On admission, blood examination showed a white blood cell count of 6290 cells/uL and a high sensitive C-reactive protein of 2.62 mg/L. CT and MR imaging with MR spectroscopy revealed an enhancing lesion involving the right motor and sensory cortex with marked perilesional edema that suggested a brain abscess. A chest CT revealed a pulmonary AVF in the right upper lung. The pulmonary AVF was obliterated with embolization. There needs to consider pulmonary AVF as an etiology of cerebral abscess when routine investigations fail to detect a source.

키워드

참고문헌

  1. Ahn KT, Choi JH, Park SW : Pulmonary arteriovenous fistula in a patient with cryptogenic stroke. Heart 97 : 2093, 2011 https://doi.org/10.1136/heartjnl-2011-300470
  2. Arivazhagan A, Pandey P, Anandh B, Abraham RG, Indira DB, Sampath S, et al. : An unusual etiology of recurrent cerebral abscesses-a report of 3 cases. Surg Neurol 71 : 241-244; discussion 245, 2009 https://doi.org/10.1016/j.surneu.2007.07.044
  3. Berthrong M, Sabiston DC Jr : Cerebral lesions in congenital heart disease, a review of autopsies on 162 cases. Bull Johns Hopkins Hosp 89 : 384-406, 1951
  4. Caroli M, Arienta C, Rampini PM, Balbi S : Recurrence of brain abscess associated with asymptomatic arteriovenous malformation of the lung. Neurochirurgia (Stuttg) 35 : 167-170, 1992
  5. Cartin-Ceba R, Swanson KL, Krowka MJ : Pulmonary arteriovenous malformations. Chest 144 : 1033-1044, 2013 https://doi.org/10.1378/chest.12-0924
  6. Chessa M, Drago M, Krantunkov P, Bini MR, Butera G, De Rosa G, et al. : Differential diagnosis between patent foramen ovale and pulmonary arteriovenous fistula in two patients with previous cryptogenic stroke caused by presumed paradoxical embolism. J Am Soc Echocardiogr 15 : 845-846, 2002 https://doi.org/10.1067/mje.2002.120289
  7. Corson MA, Postlethwaite KP, Seymour RA : Are dental infections a cause of brain abscess? Case report and review of the literature. Oral Dis 7 : 61-65, 2001 https://doi.org/10.1034/j.1601-0825.2001.70112.x
  8. Dines DE, Arms RA, Bernatz PE, Gomes MR : Pulmonary arteriovenous fistulas. Mayo Clin Proc 49 : 460-465, 1974
  9. Dines DE, Seward JB, Bernatz PE : Pulmonary arteriovenous fistulas. Mayo Clin Proc 58 : 176-181, 1983
  10. Faughnan ME, Palda VA, Garcia-Tsao G, Geisthoff UW, McDonald J, Proctor DD, et al. : International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. J Med Genet 48 : 73-87, 2011 https://doi.org/10.1136/jmg.2009.069013
  11. Hodgson CH, Kaye RL : Pulmonary arteriovenous fistula and hereditary hemorrhagic telangiectasia: a review and report of 35 cases of fistula. Dis Chest 43 : 449-455, 1963 https://doi.org/10.1378/chest.43.5.449
  12. Horiuchi Y, Kato Y, Dembo T, Takeda H, Fukuoka T, Tanahashi N : Patent foramen ovale as a risk factor for cryptogenic brain abscess: case report and review of the literature. Intern Med 51 : 1111-1114, 2012 https://doi.org/10.2169/internalmedicine.51.7133
  13. Kaido T, Moriyama Y, Ueda K, Higashiura W, Sakaguchi H, Kichikawa K : Recurrent brain abscess induced by pulmonary arteriovenous fistula. J Infect Chemother 17 : 552-554, 2011 https://doi.org/10.1007/s10156-011-0210-9
  14. Kakar A, Byotra SP, Gupta A, Jain N : Pulmonary arteriovenous fistula presenting as multiple brain abscess. J Assoc Physicians India 51 : 626-628, 2003
  15. Kawamata T, Takeshita M, Ishizuka N, Hori T : Patent foramen ovale as a possible risk factor for cryptogenic brain abscess: report of two cases. Neurosurgery 49 : 204-206; discussion 206-207, 2001
  16. Kawano H, Hirano T, Ikeno K, Fuwa I, Uchino M : Brain abscess caused by pulmonary arteriovenous fistulas without Rendu-Osler-Weber disease. Intern Med 48 : 485-487, 2009 https://doi.org/10.2169/internalmedicine.48.1678
  17. Khurshid I, Downie GH: Pulmonary arteriovenous malformation. Postgrad Med J 78 : 191-197, 2002 https://doi.org/10.1136/pmj.78.918.191
  18. Kimura K, Minematsu K, Nakajima M : Isolated pulmonary arteriovenous fistula without Rendu-Osler-Weber disease as a cause of cryptogenic stroke. J Neurol Neurosurg Psychiatry 75 : 311-313, 2004
  19. Lutz TW, Landolt H, Wasner M, Gratzl O : Diagnosis and management of abscesses in the basal ganglia and thalamus: a survey. Acta Neurochir (Wien) 127 : 91-98, 1994 https://doi.org/10.1007/BF01808554
  20. Mathisen GE, Johnson JP : Brain abscess. Clin Infect Dis 25 : 763-779; quiz 780-781, 1997 https://doi.org/10.1086/515541
  21. Momma F, Ohara S, Ohyama T, Moto A, Okada H, Harada H : Brain abscess associated with congenital pulmonary arteriovenous fistula. Surg Neurol 34 : 439-441, 1990 https://doi.org/10.1016/0090-3019(90)90251-J
  22. Moussouttas M, Fayad P, Rosenblatt M, Hashimoto M, Pollak J, Henderson K, et al. : Pulmonary arteriovenous malformations: cerebral ischemia and neurologic manifestations. Neurology 55 : 959-964, 2000 https://doi.org/10.1212/WNL.55.7.959
  23. Preston DC, Shapiro BE : Pulmonary arteriovenous fistula and brain abscess. Neurology 56 : 418, 2001 https://doi.org/10.1212/WNL.56.3.418
  24. Ratcliffe PJ, Earl CJ : Recurrent cerebral abscess in association with pulmonary arteriovenous fistulae. J Neurol Neurosurg Psychiatry 45 : 566-567, 1982 https://doi.org/10.1136/jnnp.45.6.566
  25. Sluiter-Eringa H, Orie NG, Sluiter HJ : Pulmonary arteriovenous fistula. Diagnosis and prognosis in noncomplainant patients. Am Rev Respir Dis 100 : 177-188, 1969
  26. Swanson KL, Prakash UB, Stanson AW : Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982-1997. Mayo Clin Proc 74 : 671-680, 1999 https://doi.org/10.4065/74.7.671
  27. Todo K, Moriwaki H, Higashi M, Kimura K, Naritomi H : A small pulmonary arteriovenous malformation as a cause of recurrent brain embolism. AJNR Am J Neuroradiol 25 : 428-430, 2004
  28. Watanabe N, Munakata Y, Ogiwara M, Miyatake M, Nakagawa F, Hirayama J : A case of pulmonary arteriovenous malformation in a patient with brain abscess successfully treated with video-assisted thoracoscopic resection. Chest 108 : 1724-1727, 1995 https://doi.org/10.1378/chest.108.6.1724
  29. White RI Jr, Lynch-Nyhan A, Terry P, Buescher PC, Farmlett EJ, Charnas L, et al. : Pulmonary arteriovenous malformations: techniques and longterm outcome of embolotherapy. Radiology 169 : 663-669, 1988 https://doi.org/10.1148/radiology.169.3.3186989
  30. Wong HH, Chan RP, Klatt R, Faughnan ME : Idiopathic pulmonary arteriovenous malformations: clinical and imaging characteristics. Eur Respir J 38 : 368-375, 2011 https://doi.org/10.1183/09031936.00075110
  31. Yamakuchi M, Tanaka S, Tomosugi T, Moroki K, Yamada M, Toujou H, et al. : Pulmonary arteriovenous fistula manifesting as amaurosis fugax--case report. Neurol Med Chir (Tokyo) 40 : 264-267, 2000 https://doi.org/10.2176/nmc.40.264

피인용 문헌

  1. Precision diagnosis and therapy of a case of brain abscesses associated with asymptomatic pulmonary arteriovenous fistulas vol.20, pp.None, 2017, https://doi.org/10.1186/s12879-020-05092-6