Ventriculitis: A case

Abstract

Background: Ventriculitis is an uncommon complication of intracranial infection in adults that has been variably referred to as ependymitis, venticular empyema, pyocephalus and ventriculitis. Reports about neuroimagining findings of the disease are increasing gradually. Case report: 40 year-old male patient was admitted to our department of neurology with paraparesis accompanied with vertigo, nause, ataxia and fever. On neurological examination, patient was unconscious, cooperation was limited, pupils were anisocoric, left pupil was dilated, and his left eye was ptotic. There was limited abduction and adduction of left eye. His speech was disphonic. He had urinary retention and paraparasis. Lower extremity deep tendon reflexes were abolic. He had stiff neck. Abdominal scin reflexes were negative. He was uncooperated to performed sensorial and cerebellar tests. Plantar reflexes were unresponsive. Routine laboratory investigations were within normal ranges. Serum lg values were normal. Anti HIV, anti HCV, anti TORCH antibodies were negative. CSF was xsantocromic, protein: 177mg/dl, glucose: 65mg/dl. Na: 144 mg/dl, CI: 123 mg/dl. 70 leukocyt/mm3, no growth in CSF culture. Cranial NMR obtained three weeks after the onset of his symptoms, demostrated irregular counter in T2A sequences and increased signal intensities around fourth ventricule and CSF tegmentum, right cerebellar pedincul. in addition to increased meningeal contrast enhancement in ependime surrounding ventricules. In thoracolomber NMR imaging revealed contrast enhancement in pial, meningeal in thoracal segments and cauda equina. Clinic and laboratory findings were consistent with ependymitis. Conclusion: Ependymitis is a rare clinical entity with dignostic difficulty. It was reviewed according to the features of our case in the light.