Cerebral thrombosis and abscess: A child with 2 rare complications of tetralogy of Fallot

Abstract

Tetralogy of Fallot is the most common cyanotic congenital heart disease. Rare cerebrovascular complications include brain abscess and cerebral thrombosis. Herein, we discuss a case of uncorrected tetralogy of Fallot presenting with cerebral thrombosis and multiple brain abscesses in a 1-year-and-8-month-old toddler. This patient, who was a known cardiac patient (uncorrected tetralogy of Fallot on follow-up since the age of 4 months of age), presented with a change in mentation, high-grade intermittent fever to the level of 39°C and generalized tonic-clonic type of abnormal body movement. On investigation, CBC shows leukocytosis with left shift, positive CRP (laboratory investigation included: Table 1). Blood culture was negative (blood was drawn after initiation of IV antibiotics). Head CT shows sagittal sinus thrombosis and intracranial ring-enhanced lesions (imaging discuss: Figs. 1 and 2). He was admitted and managed with anticoagulants, empiric intravenous antibiotics and aspiration of brain abscess by the neurosurgical team. Unfortunately, the patient passed away in the hospital due to neurological complications despite the above management. The purpose of reporting this extremely rare case is for educational purposes and to highlight the importance of early detection and correction of cardiac defects to prevent serious complications.