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An elderly man with dysphasia and pyrexia
  1. Department of Medicine for the Elderly, Tameside General Hospital, Ashton under Lyne OL6 9RW, UK

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    Sir,This was a very instructive case,1 not least because it cannot be emphasised too strongly that examination of the ears is a ‘must’ for all patients with neurological disease involving structures above the level of the cervical cord. For the sake of completeness, one should also mention the fourth predisposing category for cerebral abscess, namely, right to left shunt,2including drainage of the right superior vena cava into the left atrium, responsible for cerebral abscess in three of the five cases in the literature review conducted by Smith et al,3 who stressed the crucial role of echocardiography and, in selected cases, cardiac catheterisation as well, in the investigation of cerebral abscess when the three aetiopathogenetic mechanisms mentioned by Sathi and Shinton1 do not appear to be operative.3


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