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Diffusion magnetic resonance imaging diagnostic relevance in pyogenic ventriculitis with an atypical presentation: a

Lucio Marinelli1, Carlo Trompetto, Leonardo Cocito

  • 1Institute of Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Largo Daneo 3, 16132 Genova, Italy. lucio.marinelli@unige.it.

BMC Research Notes
|March 18, 2014
PubMed
Abstract

Insights

Pyogenic ventriculitis, a severe brain infection, can present subtly. Diffusion-weighted MRI is crucial for diagnosis when CT and standard MRI are inconclusive, enabling prompt vancomycin treatment for methicillin-resistant Staphylococcus aureus.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Neuroimaging

Background:

  • Pyogenic ventriculitis is a rare, severe cerebral infection with potentially non-specific neurological signs.
  • Early diagnosis can be challenging due to atypical presentations and normal initial brain imaging.
  • It is a life-threatening condition requiring prompt recognition and treatment.

Observation:

  • A patient developed unusual psychomotor slowing, facial dyskinesias, and myoclonic jerks post-surgery.
  • Clinical presentation lacked typical signs of central nervous system infection like headache or meningeal irritation.
  • Cerebrospinal fluid analysis identified methicillin-resistant Staphylococcus aureus.

Findings:

  • Standard computed tomography (CT) scans were normal.
  • Diffusion-weighted magnetic resonance imaging (MRI) sequences were essential in detecting purulent material in the lateral ventricles.
  • Vancomycin treatment resulted in complete recovery.

Implications:

  • Highlights the importance of considering pyogenic ventriculitis in atypical neurological presentations.
  • Emphasizes the diagnostic limitations of CT and standard MRI in such cases.
  • Underscores the critical role of diffusion-weighted MRI sequences in diagnosing cerebral pyogenic ventriculitis and guiding treatment.

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