Work

Cerebrospinal fluid leak-associated ventriculitis – a case report

Year: 2024

Type: article

Abstract: • Suspect CSF leak-associated ventriculitis when managing recurrent meningitis with existing or historical otorrhoea/rhinorrhoea. • Gadolinium-enhanced MRI brain is the choice modality for suspected ventriculitis. • Resort to skull base imaging if 1) nasal/ear fluid positive for beta-2-transferrin, and 2) historical otorrhoea/rhinorrhoea presents with recurrent meningitis. We present a case of a 74-year-old woman with headaches, pyrexia and intermittent right-sided otorrhoea and rhinorrhoea. Her nasal discharge tested positive for beta-2-transferrin, confirming a cerebrospinal fluid (CSF) leak. High-resolution CT (HRCT) mastoids showed a defect in the right tegmen, and CSF within the middle ear and mastoid air cells. A gadolinium-enhanced MRI brain showed high signal in the occipital horns of the lateral ventricles with diffusion-weighted imaging (DWI) and a low signal with DWI-apparent diffusion coefficient (DWI-ADC), consistent with ventriculitis. She made an uneventful recovery after 6 weeks of intravenous antibiotics. The patient had surgical repair of bony defects to prevent recurrence. This highlights a rare case of ventriculitis associated with a spontaneous CSF leak, with no existing set diagnostic criteria, and high mortality. High clinical suspicion aided by appropriate imaging, and a multidisciplinary approach to management are imperative.

Source: Clinical Medicine

DOI: 10.1016/j.clinme.2024.100279

Authors: Amir Waheed, Faryal Amir

Institutions: Great Western Hospital, St Mary's Hospital

Language: English

Topic: Neurosurgical Procedures and Complications

Subfield: Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,500