Cerebral abscess with ventriculitis

Case contributed by Dr Heba Mohamed

Presentation

This patient underwent surgery to his left ear two weeks ago. He recently developed fits and a disturbed conscious level.

Patient Data

Age: Adult
Gender: Male

Conventional MRI of the brain demonstrates diffuse abnormal signal and vasogenic edema involving the left temporal lobe and abnormally dilated supratentorial ventricular system.

High T1 signal of the left occipital lobe cortex representing areas of cortical laminar necrosis as well as the high signal of the left occipital horn well demonstrated on axial T1 and axial FLAIR (ventricular debris).  Associated transependymal oedema.

DWI and ADC show area of restricted diffusion within the left temporal lobe and the left occipital horn content.

Post-contrast images demonstrate a left temporal lesion with ring enhancement pattern as well as ependymal enhancement of the left lateral ventricular wall.

 

Case Discussion

The patient's surgery was complicated with cerebral infection in the form of a left temporal lobe abscess with ventriculitis. 

Signs of ventriculitis include:

  1. ventricular debris, the debris is hyperintense to CSF on T1-weighted images and DWI and hypointense to CSF on T2-weighted images and ADC
  2. hydrocephalus
  3. the periventricular hyperintense signal of trans ependymal oedema
  4. ventricular wall enhancement. Septations of the ventricle usually encountered later on

 

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Case information

rID: 52016
Case created: 18th Mar 2017
Last edited: 21st Mar 2017
Inclusion in quiz mode: Included

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