Ventrikulitis

Rare case of

fatal ventriculitis in a term neonate following myelomeningocele repair. Axial head ultrasound 2 weeks after uncomplicated repair of myelomeningocele showing hydrocephalus and intraventricular septations.

www.eurorad.org • CC by-nc-sa-4.0

Rare case of

fatal ventriculitis in a term neonate following myelomeningocele repair. Sagittal head ultrasound showing debris and fibrin strands within the dilated lateral ventricle.

www.eurorad.org • CC by-nc-sa-4.0

Ventriculitis

• Multiple cerebral abscess post head injury - Ganzer Fall bei Radiopaedia

Gaillard F, Multiple cerebral abscess post head injury. Case study, Radiopaedia.org (Accessed on 23 Nov 2022) https://doi.org/10.53347/rID-5533 • CC by-nc-sa 3.0 (modified)

HIV/AIDS (CNS

manifestations) • CMV ventriculitis and encephalitis - Ganzer Fall bei Radiopaedia

Gaillard, F. CMV ventriculitis and encephalitis. Case study, Radiopaedia.org. (accessed on 20 Oct 2022) https://doi.org/10.53347/rID-5416 • CC by-nc-sa 3.0 (modified)

Brain abscess

• Cerebral abscess and ventriculitis - Ganzer Fall bei Radiopaedia

Gaillard F, Cerebral abscess and ventriculitis. Case study, Radiopaedia.org (Accessed on 18 Nov 2022) https://doi.org/10.53347/rID-5024 • CC by-nc-sa 3.0 (modified)

Ventriculitis

• Ventriculitis - Ganzer Fall bei Radiopaedia

Chivate R, Ventriculitis. Case study, Radiopaedia.org (Accessed on 23 Nov 2022) https://doi.org/10.53347/rID-24964 • CC by-nc-sa 3.0 (modified)

Ventriculitis

• Ventriculitis: on a background of congenital hydrocephalus - Ganzer Fall bei Radiopaedia

Alabd M, Ventriculitis: on a background of congenital hydrocephalus. Case study, Radiopaedia.org (Accessed on 23 Nov 2022) https://doi.org/10.53347/rID-43230 • CC by-nc-sa 3.0 (modified)

CNS

infectious diseases • Pyogenic ventriculitis - Ganzer Fall bei Radiopaedia

Di Muzio, B. Pyogenic ventriculitis. Case study, Radiopaedia.org. (accessed on 20 Oct 2022) https://doi.org/10.53347/rID-54386 • CC by-nc-sa 3.0 (modified)

Brain abscess

• Brain abscess with ventriculitis - Ganzer Fall bei Radiopaedia

Hanh L, Brain abscess with ventriculitis. Case study, Radiopaedia.org (Accessed on 18 Nov 2022) https://doi.org/10.53347/rID-85703 • CC by-nc-sa 3.0 (modified)

Teenager with

fever and mental status changes. Axial CT with contrast of the brain shows ring enhancing lesions in the anterior horn of the left lateral ventricle and faint enhancement of the ependymal lining of the ventricles. There is hydrocephalus present as well as effacement of the basilar cisterns. The diagnosis was intraventricular intracranial abscess causing communicating hydrocephalus. When a ventriculostomy catheter was placed, pus shot out of it.

pediatricimaging.org • CC-by-nc-sa 4.0

Ventriculoperitoneal

shunt complications: a local study at Qena University Hospital: a retrospective study. CT brain axial view of a 16-month-old female patient showing left-sided VP shunt causing picture of ventriculitis

EJNS.springeropen.com • CC-by-4.0

Radiopaedia • CC-by-nc-sa 3.0 • de

Ventriculitis (plural: ventriculitides) refers to inflammation, usually due to infection, of the ependymal lining of the cerebral ventricles. It is most often due to meningitis.

Terminology

The entity or closely related variants have also been variously referred to as ependymitis, ventricular empyema, intraventricular abscess, and pyocephalus .

Epidemiology

Its epidemiology is varied and depends on the underlying cause.

Pathology

Etiology

meningitis (both pyogenic and viral): most common
cerebral abscess
shunt/EVD related
trauma
CSF leakage
a complication of intrathecal chemotherapy and neurosurgery

Meningitis is the most common underlying condition responsible for the ventriculitis. It is directly related to lower host immunity and higher virulence of the causative organism. The occurrence of direct haematogenous spread to the choroid plexus has also been suggested. In long-standing cases (>2 months) ventricular septations develop which result in compartmentalization and multiloculated hydrocephalus and makes prognosis worse.

Radiographic features

Ultrasound

Neonatal cranial ultrasound can show increased periventricular echogenicity and irregularity of the ventricular surface. Choroid plexus irregularity (thought to be due to haematogenous spread via the choroid plexus) can also be seen. Additionally, echogenic intraventricular debris may be present. When present, intraventricular septations may be well delineated on ultrasound .

CT

Non-contrast CT of the brain usually demonstrates only non-specific features, most frequently dependent hyperdense layering material, particularly in the occipital horns of the lateral ventricles .

Hydrocephalus and periventricular low density (which probably represents reactive edema rather than transependymal edema related to hydrocephalus ) are also frequently present, as may also be the features of the underlying abnormality (e.g. meningitis, shunt/EVD, trauma)

Following administration of contrast, thin uniform enhancement of the ependymal lining of the ventricles may be seen.

MRI

MRI demonstrates the same features as CT, with layering debris in the occipital horns frequently seen. There often an intense restricted diffusion of these intraventricular debris, as seen in the center of a brain abscess.

MRI is also more sensitive to the often subtle periventricular abnormal signal (high T2) and thin contrast enhancement.

Additionally, the periventricular region may demonstrate restricted diffusion on DWI and ADC.

Differential diagnosis

The main differential diagnosis is that of ependymal lining enhancement, which includes ependymal spreading of glioblastoma or primary CNS lymphoma. In these cases, the enhancement is, usually, bumpy/nodular. Extracranial neoplasm metastases and germinoma may also be responsible for similar findings.