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Verma N, Gupta N. Septic Emboli to the Brain Secondary to a Patent Foramen Ovale: A Rare Complication of Internal Jugular Vein Catheter. Cureus 2024; 16:e59419. [PMID: 38826600 PMCID: PMC11140158 DOI: 10.7759/cureus.59419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
The prolonged use of hemodialysis catheters is associated with several complications with infection being the most common. The increased susceptibility to infections in patients on hemodialysis can be attributed to decreased immunity, though age, other comorbidities, and properties of the catheter act as modifiers. Hematogenous spread of the infection can lead to sepsis and seeding into other organs. In this article, we report an unusual case of septic emboli to the brain in a 30-year-old male on prolonged use of a right internal jugular vein (IJV) catheter for hemodialysis. An interesting finding in the case was the presence of a patent foramen ovale (PFO), a persisting embryonic structure that allows right-to-left shunting. It is suspected that this PFO led to the passage of septic emboli from the right IJV site to the brain. Before our case, septic emboli to the brain have been reported to occur from valvular vegetation in case of infective endocarditis. The mainstay of managing patients with septic emboli is the use of antibiotics; additional interventions may be needed on a case-to-case basis.
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Affiliation(s)
- Nikhil Verma
- Oncology, Metro Heart Institute With Multispeciality, Faridabad, IND
| | - Nimish Gupta
- Nephrology, Metro Heart Institute With Multispeciality, Faridabad, IND
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2
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Wager SG, Bourdeau NK, Collins JD. Streptococcus constellatus Brain Abscess in a Middle-Aged Man With an Undiagnosed Patent Foramen Ovale. Cureus 2023; 15:e34626. [PMID: 36891022 PMCID: PMC9987340 DOI: 10.7759/cureus.34626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/07/2023] Open
Abstract
Brain abscess is a rare diagnosis. Common sources of infection include direct spread from otic sources, sinuses, or oral cavities, and hematogenous spread from distant sources, including the heart and lungs. Brain abscess with cultures growing oral flora species, in rare cases, may develop from bacteria in the oral cavity entering the bloodstream and then traveling to the brain via a patent foramen ovale. This report highlights a case of brain abscess caused by Streptococcus constellatus in a middle-aged man with an undiagnosed patent foramen ovale.
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Affiliation(s)
- Susan G Wager
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Nina K Bourdeau
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
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3
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Li C, Hao S, Wang J, Gao Z, Ji N. Severe cerebral abscess associated with pulmonary arteriovenous fistula: case report and literature review. Chin Neurosurg J 2018; 4:30. [PMID: 32922891 PMCID: PMC7398252 DOI: 10.1186/s41016-018-0137-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/11/2018] [Indexed: 11/25/2022] Open
Abstract
Background A rare case of cerebral abscess concurrent with pulmonary arteriovenous fistula (PAVF), hyperhemoglobinemia, and hypoxemia was reported. Case presentation A 37-year-old man was admitted with a headache, nausea, vomiting, fever, and numbness of the left cheek and upper limb for 10 days. Cerebral magnetic resonance imaging (MRI) shows the lesion in his right frontal lobe. Blood gas analysis indicated lower blood oxygen saturation level, and blood routine test showed hemoglobin elevation. Craniotomy for the lesion and decompressive craniotomy were performed. Brain abscess was confirmed by pathology examination. The chest computed tomography angiography (CTA) revealed a pulmonary arteriovenous fistula (PAVF) in his right lower lung. After 1 month, embolization of PAVF was performed. Anoxic symptom improved after surgery. Cranioplasty was performed after 7 months. Conclusion The author reported a rare case of cerebral abscess associated with pulmonary arteriovenous fistula. Brain abscess, hyperhemoglobinemia, and hypoxemia might be secondary to PAVF. Treatment of patients includes not only craniotomy for abscess removal but also embolization of PAVF which can prevent recurrence of brain abscess.
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Affiliation(s)
- Chunzhao Li
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brian Tumor, Beijing, China.,China National Clinical Research Center for Neurological Diseases Beijing, Beijing, China
| | - Shuyu Hao
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brian Tumor, Beijing, China.,China National Clinical Research Center for Neurological Diseases Beijing, Beijing, China
| | - Jiangfei Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brian Tumor, Beijing, China.,China National Clinical Research Center for Neurological Diseases Beijing, Beijing, China
| | - Zhixian Gao
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brian Tumor, Beijing, China.,China National Clinical Research Center for Neurological Diseases Beijing, Beijing, China
| | - Nan Ji
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brian Tumor, Beijing, China.,China National Clinical Research Center for Neurological Diseases Beijing, Beijing, China
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4
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Chandra A, Li WA, Stone CR, Geng X, Ding Y. The cerebral circulation and cerebrovascular disease I: Anatomy. Brain Circ 2017; 3:45-56. [PMID: 30276305 PMCID: PMC6126264 DOI: 10.4103/bc.bc_10_17] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/28/2017] [Accepted: 06/07/2017] [Indexed: 11/28/2022] Open
Abstract
In this paper, which is the first in a three-part series that reviews cerebrovascular anatomy, pathogenesis, and stroke, we lay the anatomical foundation for the rest of the series. Beginning with its origin in the branches of the aorta, we start by describing the arterial system. This system is partitioned into two major divisions (anterior and posterior circulations) that differ significantly in features and pathogenic potential. The systems, and the major branches that comprise them, are described. Description of the arterial system proceeds to the point of the fulfillment of its function. This function, the exchange of gases and nutrients with the cerebral parenchyma, is the subject of a subsequent section on the microcirculation and blood-brain barrier. Finally, the cerebral venous system, which is composed of cerebral veins and dural venous sinuses, is described. Thus, an anatomical context is supplied for the discussion of cerebrovascular disease pathogenesis provided by our second paper.
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Affiliation(s)
- Ankush Chandra
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - William A Li
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Christopher R Stone
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaokun Geng
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
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5
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Nam TK, Park YS, Kwon JT. Brain Abscesses Associated with Asymptomatic Pulmonary Arteriovenous Fistulas. J Korean Neurosurg Soc 2017; 60:118-124. [PMID: 28061502 PMCID: PMC5223758 DOI: 10.3340/jkns.2015.0707.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/03/2015] [Accepted: 02/05/2016] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Taek-Kyun Nam
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yong-Sook Park
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong-Taik Kwon
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
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Alvis Miranda H, Castellar-Leones SM, Elzain MA, Moscote-Salazar LR. Brain abscess: Current management. J Neurosci Rural Pract 2013; 4:S67-81. [PMID: 24174804 PMCID: PMC3808066 DOI: 10.4103/0976-3147.116472] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Brain abscess (BA) is defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis, which is subsequently converted into a collection of pus within a well-vascularized capsule. BA must be differentiated from parameningeal infections, including epidural abscess and subdural empyema. The BA is a challenge for the neurosurgeon because it is needed good clinical, pharmacological, and surgical skills for providing good clinical outcomes and prognosis to BA patients. Considered an infrequent brain infection, BA could be a devastator entity that easily left the patient into dead. The aim of this work is to review the current concepts regarding epidemiology, pathophysiology, etiology, clinical presentation, diagnosis, and management of BA.
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Affiliation(s)
| | | | - Mohammed Awad Elzain
- Department of Neurosurgery, National Center for Neurological Sciences, Shaab Hospital, Khartoum, Sudan
| | - Luis Rafael Moscote-Salazar
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Hospital Ángeles de Pedregal, Mexico City, Colombia
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7
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Higuchi K, Ishihara H, Okuda S, Kanda F. A 51-year-old man with intramedullary spinal cord abscess having a patent foramen ovale. BMJ Case Rep 2011; 2011:bcr.11.2010.3512. [PMID: 22696715 DOI: 10.1136/bcr.11.2010.3512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors report a case of a 51-year-old man with intramedullary spinal cord abscess (ISCA) having a patent foramen ovale (PFO). He developed fever and tetraplegia after a recent dental treatment. MRI showed ISCA with longitudinal swelling from the upper cervical to the lumbar spinal cord. Cerebrospinal fluid (CSF) analysis indicated bacterial meningitis, and the culture of CSF revealed Streptococcus viridans. Transoesophageal echocardiography revealed the existence of a PFO. We suspected another possibility other than systemic bacteraemia, that paradoxical bacteric embolisation through PFO after the dental treatment caused ISCA. While several reports of brain abscess with PFO are available, this is the first report of ISCA with PFO.
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Affiliation(s)
- Kanako Higuchi
- Department of Neurology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan.
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8
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Ariyaratnam S, Gajendragadkar PR, Dickinson RJ, Roberts P, Harris K, Carmichael A, Karas JA. Liver and brain abscess caused by Aggregatibacter paraphrophilus in association with a large patent foramen ovale: a case report. J Med Case Rep 2010; 4:69. [PMID: 20181252 PMCID: PMC2845142 DOI: 10.1186/1752-1947-4-69] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 02/24/2010] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Aggregatibacter paraphrophilus (former name Haemophilus paraphrophilus) is a normal commensal of the oral flora. It is a rare cause of hepatobiliary or intracerebral abscesses. CASE PRESENTATION We report a case of a 53-year-old Caucasian man with a liver abscess and subsequent brain abscesses caused by Aggregatibacter paraphrophilus. The probable source of the infection was the oral flora of our patient following ingestion of a dental filling. The presence of a large patent foramen ovale was a predisposing factor for multifocal abscesses. CONCLUSION In this case report, we describe an unusual case of a patient with both liver and brain abscesses caused by an oral commensal Aggregatibacter paraphrophilus that can occasionally show significant pathogenic potential.
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Affiliation(s)
- Shaumya Ariyaratnam
- Department of Medicine, Hinchingbrooke Health Care NHS Trust, Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, PE29 6NT, UK
| | - Parag R Gajendragadkar
- Department of Medicine, Hinchingbrooke Health Care NHS Trust, Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, PE29 6NT, UK
| | - Richard J Dickinson
- Department of Medicine, Hinchingbrooke Health Care NHS Trust, Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, PE29 6NT, UK
| | - Phil Roberts
- Department of Medicine, Hinchingbrooke Health Care NHS Trust, Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, PE29 6NT, UK
| | - Kathryn Harris
- Department of Microbiology, Level 4 Camelia Botnar Laboratories, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Andrew Carmichael
- Department of Infectious Diseases, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Johannis A Karas
- Department of Medicine, Hinchingbrooke Health Care NHS Trust, Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, PE29 6NT, UK
- Health Protection Agency, East of England, Microbiology Laboratory, Papworth Hospital, Ermine Road, Papworth Everard, CB23 3RE, UK
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Jan F, Hafiz AM, Gupta S, Meidl J, Allaqaband S. Brain abscesses in a patient with a patent foramen ovale: a case report. J Med Case Rep 2009; 3:9299. [PMID: 20062788 PMCID: PMC2803822 DOI: 10.1186/1752-1947-3-9299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 11/25/2009] [Indexed: 11/25/2022] Open
Abstract
Introduction Brain abscesses arising from right-to-left cardiac shunting are very rare in adults. Case presentation We describe the case of a 47-year-old non-hispanic white male with periodontal disease who developed several brain abscesses caused by Streptococcus intermedius. A comprehensive workup revealed a patent foramen ovale with oral flora as the only plausible explanation for the brain abscesses. Conclusion Based on this case and the relevant literature, we suggest an association between a silent patent foramen ovale, paradoxical microbial dissemination to the brain, and the development of brain abscesses.
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Affiliation(s)
- Fuad Jan
- Department of Medicine, Division of Cardiovascular Disease, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, North 12th Street, Milwaukee, Wisconsin, 53233, USA
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10
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Stathopoulos GT, Mandila CG, Koukoulitsios GV, Katsarelis NG, Pedonomos M, Karabinis A. Adult brain abscess associated with patent foramen ovale: a case report. J Med Case Rep 2007; 1:68. [PMID: 17718904 PMCID: PMC2018709 DOI: 10.1186/1752-1947-1-68] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 08/24/2007] [Indexed: 11/15/2022] Open
Abstract
Brain abscess results from local or metastatic septic spread to the brain. The primary infectious site is often undetected, more commonly so when it is distant. Unlike pediatric congenital heart disease, minor intracardiac right-to-left shunting due to patent foramen ovale has not been appreciated as a cause of brain abscess in adults. Here we present a case of brain abscess associated with a patent foramen ovale in a 53-year old man with dental-gingival sepsis treated in the intensive care unit. Based on this case and the relevant literature we suggest a link between a silent patent foramen ovale, paradoxic pathogen dissemination to the brain, and development of brain abscess.
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Affiliation(s)
| | | | | | | | - Michel Pedonomos
- Intensive Care Unit, General Hospital "G. Gennimatas", Athens, Greece
| | - Andreas Karabinis
- Intensive Care Unit, General Hospital "G. Gennimatas", Athens, Greece
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11
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Piechowski-Jozwiak B, Devuyst G, Bogousslavsky J. Migraine and Patent Foramen Ovale: A Residual Coincidence or a Pathophysiological Intrigue? Cerebrovasc Dis 2006; 22:91-100. [PMID: 16685120 DOI: 10.1159/000093236] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Accepted: 01/24/2006] [Indexed: 11/19/2022] Open
Abstract
Migraine is one of the most common neurological disorders and one of the most frequent primary headaches. It imposes a significant burden on the affected individuals, society and health care system. As the etiology and pathophysiology of migraine are not well understood, treatment is largely symptomatic. Patent foramen ovale is a remnant of a fetal circulation and is highly prevalent in the general population. Its presence was linked to several disorders including migraine. The aim of this review was to search in the available data the answer to the question whether the link between migraine and patent foramen ovale is coincidental or whether they represent a pathophysiological entity.
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Affiliation(s)
- B Piechowski-Jozwiak
- Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Kaplan M, Topsakal C, Cihangiroglu M. Hemorrhage into the brain abscess cavity with Fallot's tetralogy. Pediatr Neurosurg 2006; 42:65-6. [PMID: 16357506 DOI: 10.1159/000089514] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hemorrhage into the abscess cavity is a complication of brain abscess. It has been reported to be due to inflammation which results in the damage of the fragile neovasculature of the abscess wall. Hypoxia caused by Fallot's tetralogy or other congenital heart diseases facilitates the damage of these vessels with the lacking supportive tissues, and in turn intracavital bleeding.
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Affiliation(s)
- Metin Kaplan
- Department of Neurosurgery, School of Medicine, Firat University, Elaziğ, Turkey.
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Kwapisz MM, Deinsberger W, Müller M, Nopens H, Neuhäuser C, Klasen J, Hempelmann G. Transesophageal Echocardiography as a Guide for Patient Positioning Before Neurosurgical Procedures in Semi-sitting Position. J Neurosurg Anesthesiol 2004; 16:277-81. [PMID: 15557830 DOI: 10.1097/00008506-200410000-00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
With an incidence of a patent foramen ovale in nearly one fourth of the normal population, neurosurgical procedures in the semi-sitting position are associated with the risk of paradoxical air embolism. The present study was undertaken to evaluate an anesthetic concept to detect a patent foramen ovale with the help of transesophageal echocardiography in anesthetized patients before neurosurgical procedures in the semi-sitting position. Transesophageal echocardiography was performed after induction of anesthesia before surgery to avoid additional physical and psychologic stress for the patients. Thirty-five neurosurgical patients scheduled for elective surgery in the semi-sitting position were examined with help of contrast transesophageal echocardiography. The data of the examined patients were analyzed with respect to efficiency, logistic efforts, and adverse events. Contrast transesophageal echocardiography was combined with a ventilation maneuver to increase right atrial pressure. A patent foramen ovale was detected in 3 of 35 patients. These patients were operated on in a supine position. Oral insertion of the echoprobe was possible in all patients without difficulties. A short-lasting hypertension was observed in 5 patients despite adequate analgesia and sedation. The average time of examination was 25 minutes. None of the patients showed paradoxical air embolism as judged by postoperative neurologic assessment. Contrast transesophageal echocardiography combined with a ventilation maneuver is an effective method in detecting a patent foramen ovale. Moreover, transesophageal echocardiography is a clinical guide to patient positioning. The method of anesthetic management presented to examine anesthetized patients immediately before surgery means less physical and psychologic stress for the patients and causes approximately a 30-minute delay of surgery.
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Affiliation(s)
- Myron M Kwapisz
- Department of Anaesthesiology, Intensive Care Medicine, Pain Therapy, University Hospital Giessen, Giessen, Germany
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14
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Kundra SN. Patent Foramen Ovale as a Possible Risk Factor for Cryptogenic Brain Abscess: Report of Two Cases. Neurosurgery 2002. [DOI: 10.1227/00006123-200203000-00057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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15
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Kawamata T, Takeshita M. Patent Foramen Ovale as a Possible Risk Factor for Cryptogenic Brain Abscess: Report of Two Cases. Neurosurgery 2002. [DOI: 10.1227/00006123-200203000-00058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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