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Ventriculitis


KEY FACTS

Terminology

  • Ventricular ependyma infection related to meningitis, ruptured brain abscess, or ventricular catheter

Imaging

  • Best imaging clue: Ventriculomegaly with debris level, abnormal ependyma, periventricular T2/FLAIR hyperintensity

  • DWI

    • Restriction of layering debris with low ADC is characteristic

  • T1WI C+

    • Marked ependymal enhancement with ventriculomegaly

  • Ultrasound

    • Ventriculomegaly with echogenic ependyma and debris in infant

      • –

        Can play important role in detection of postinfectious hydrocephalus

Top Differential Diagnoses

  • Primary CNS lymphoma

  • Ependymal tumor spread (e.g., glioblastoma multiforme, medulloblastoma, pineal and choroid plexus tumors, ependymoma)

  • Intraventricular hemorrhage

  • Prominent ependymal veins (e.g., arteriovenous malformation, developmental venous anomaly, cavernoma, Sturge-Weber)

Clinical Issues

  • Bacterial ventriculitis may occur in healthy individuals after trauma or neurosurgical procedure

  • Fungal or viral ventriculitis occurs most commonly in immunosuppressed patients

  • Ventriculitis occurs in 30% of meningitis patients; up to 80-90% in neonates/infants

  • High mortality rate: 40-80%

  • Treatment: Surgical irrigation, drainage, &/or IV antibiotics

Axial graphic shows a right frontal abscess that has ruptured into the ventricular system, resulting in ventriculitis. Note the characteristic debris level within the ventricles and the inflammation along the ventricular margins
.

Axial FLAIR MR shows striking hyperintensity along the ventricular ependyma
with hyperintense debris filling the atria of the lateral ventricles
. FLAIR and DWI are the most sensitive sequences to identify ventriculitis. Note the right basal ganglia abscess
.

Axial DWI MR in a patient with pneumococcal meningitis shows diffusion restriction in 3rd ventricle
and lateral ventricular debris
due to an associated ventriculitis. Exudates are in superior cerebellar cistern
and a small subdural empyema
. DWI is invaluable in the diagnosis of ventriculitis.

Axial T1WI C+ MR in the same patient shows dependent ventricular debris
, ependymal
as well as leptomeningeal enhancement
.

TERMINOLOGY

Synonyms

  • Ependymitis, ventricular abscess, pyocephalus

Definitions

  • Ventricular ependyma infection related to meningitis, ruptured brain abscess, or ventricular catheter

IMAGING

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