A Case Of Brain Abscesses in Bilateral Basal Ganglia Due To Infective Endocarditis: Role Of The Vascular (Virchow-Robin) Space As Infective Route

We report a patient with bilateral basal ganglia brain abscesses due to infective endocarditis. A 63-year-old man admitted in an emergency with decreased consciousness was found in echocardiography on admission to have vegetation on the aortic valve. Initial cranial CT showed niveau formation in both lateral ventricles. On hospital day 4, brain CT and MRI showed bilateral basal ganglia brain abscesses and hydrocephalus. He underwent ventricle drainage but died on hospital day 14. An autopsy showed abscesses on the bilateral basal ganglia and in the perivascular (Virchow-Robin) spaces. Virchow-Robin spaces are those between the pia mater and intercellular compartments around perforating arteries. They are especially prominent in the basal ganglia. We speculated that he had meningoventriculitis because of the infective endocarditis that had proceeded through the Virchow-Robin spaces to form brain abscesses.