Suspicious seizures: Uncommon complication of PFO/ASA.

Brain abscesses have cardiac etiology in 5% of cases with valvular heart disease and endocarditis being the most common. Congenital heart disease with the risk of right to left shunt and paradoxical embolization is also a culprit. Our case describes a young patient with a prior undiagnosed patent foramen ovale (PFO), who presented with solitary brain abscess without any underlying primary source of infection. Since there was no evidence of contiguous spread of infection by computed tomography or magnetic resonance imaging scans, hematogenous spread of the streptococcal species was the most likely etiology. Transesophageal echocardiography (TEE) revealed no evidence of valvular endocarditis but did show intracardiac right-to-left shunting via a PFO. We suggest that all patients with a brain abscess of an unclear etiology caused be screened for a PFO with a TEE and bubble study.