BRAIN ABSCESS ASSOCIATED WITH CONGENITAL HEART DISEASE

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Abstract
A review of the literature reveals 41 adequately documented cases of cerebral abscess associated with congenital heart disease. Three cases of cerebral abscess occurring in 39 autopsied cases of congenital heart disease are reported in this paper. The clinical signs and symptoms of cerebral abscess are presented with special emphasis on the need for early surgical intervention. The occurrence of persistent headache or lethargy in a patient with congenital heart disease should be thoroughly investigated. Spinal tap, EEG and cranial air studies should be done before the diagnosis of cerebral abscess is excluded. Several authors believe that an area of infarction in the brain precedes the development of an abscess although this process alone has not been reported in congenital heart disease. Five instances of cerebral infarction were observed in 39 autopsies on individuals with congenital heart disease. A number of possible explanations have been offered for the development of infarction: paradoxic emboli, emboli from the lungs through the systemic arterial circulation by way of the pulmonary vein, left auricle and ventricle, emboli from the lungs through the spinal veins and finally, as a result of thrombosis of the cerebral arteries. In addition to pulmonary and cerebral thrombosis, thrombi were found in the iliac, popliteal and renal arteries. The tendency to systemic and pulmonary thromboses in cases of congenital heart disease is best explained on the basis of decreased flow of blood due either to polycythemia or to decreased pulmonary blood flow. Significant cerebral lesions of various kinds were found in 22 of 39 cases of congenital heart disease.

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