Brain abscess: Intracradiac Shunt

Case Report : 55 year old female presented with left sided focal seizures.  On examination, she had mild pyramidal weakness of left upper and lower limbs. Left plantar was extensor. There was cortical sensory loss on left upper and lower limbs. CVS examination  showed loud P2 and Ejection systolic murmur over the pulmonary area.  On MRI there is smooth ring enhancing lesion, which appeared bright on DW-MRI suggesting abscess. CXR and CT chest showed grossly dilated main pulmonary artery as well as branches. Echo showed ostium secundum ASD with  intracardiac shunt and moderately severe pulmonary artery hypertension.  Final diagnosis of brain abscess secondary to intracardiac shunt was made.  Submitted by Dr Rahul Rajeev DM (Neurology) Std, Dr Sumer Sethi, MD RadiologyThe most common cyanotic heart diseases associated with brain abscess are tetralogy of Fallot and transposition of great vessels. In patients with cyanotic heart disease with the right to left shunt, venous blood in the heart bypasses the pulmonary circulation, thus preventing the phagocytosis of the infective organisms by the pulmonary macrophages. These patients also have polycythemia that increases blood viscosity. The resultant hypo perfusion of areas in the brain and metabolic acidosis predisposes to seeding of the infective foci into areas of microinfarcts. In a patient with an ASD, a paradoxical embolus can cause a brain abscess, although few such cases are reported i...
Source: Sumer's Radiology Site - Category: Radiology Authors: Source Type: blogs

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Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
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Source: Am J Physiol Gastroi... - Category: Gastroenterology Authors: Tags: Am J Physiol Gastrointest Liver Physiol Source Type: research
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Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Cardiology - Clinical Clinical cardiology Uncategorized does raised rvedp cause dyspnea dyspnea in pulmonary hypertension mechanism of dyspnea Source Type: blogs
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Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
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Source: Cardiovascular Journal of Africa - Category: Cardiology Authors: Tags: Cardiovasc J Afr Source Type: research
A 50-something woman with history of CHF of unknown etiology, and of HTN, presented for evaluation of chest pressure.Her BP was 223/125, Sp02 98% on RA. HR 106, RR 18. Here was her ED ECG:There is sinus rhythm with Left Bundle Branch Block (LBBB)There is a large amount of ST Elevation in V2 and V3 (more than 5 mm)Thus, this meets the unweighted Sgarbossa Criteria of 5 mm of discordant ST ElevationBut it does NOT meet the Smith Modified Sgarbossa Criteria, which depend on the ST/S ratio.This ratio is critical because LBBB with very large depolarization voltage (QRS) also has very large repolarization voltage (ST/T).Her...
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Source: Age and Ageing - Category: Geriatrics Source Type: research
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Source: Current Respiratory Care Reports - Category: Respiratory Medicine Source Type: research
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Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Cardiovascular Clinical Science Posters Source Type: research
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Source: Frontiers in Physiology - Category: Physiology Source Type: research
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