Brain abscess results from local or metastatic septic spread to the brain. The primary infectious site is often undetected, more commonly so when it is distant. Unlike pediatric congenital heart disease, minor intracardiac right-to-left shunting due to patent foramen ovale has not been appreciated as a cause of brain abscess in adults. Here we present a case of brain abscess associated with a patent foramen ovale in a 53-year old man with dental-gingival sepsis treated in the intensive care unit. Based on this case and the relevant literature we suggest a link between a silent patent foramen ovale, paradoxic pathogen dissemination to the brain, and development of brain abscess.

Vertebral artery dissection in two patients with traumatic brain and cervical spine injury was treated in the intensive care unit. In both cases vertebral artery dissection was suspected solely by the presence of ischemic lesions on the cervical spine and by magnetic resonance imaging of the brain, performed because of a failure to recover consciousness. In the intensive care unit patients with head and neck trauma, symptoms of posterior circulation ischemia due to traumatic vertebral artery dissection, often overlap with those with traumatic brain injury. A high level of suspicion for vertebral artery dissection has to be maintained in order to prompt further investigation in to these cases.

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