Ventriculitis after emergent arch aneurysm surgery

A 72-year-old man was referred to our institution because of an arch aneurysm and acute aortic dissection (thrombosed Stanford type A). Anti-impulse therapy was initiated. He developed a high fever after admission. Blood culture was negative. Five days after admission, he developed back pain. Thoracoabdominal computed tomography revealed a new low-density area from the distal arch to the descending aorta. We performed emergent total arch replacement. Although we discontinued all sedative drugs after surgery, coma continued. Brain magnetic resonance imaging with diffusion-weighted imaging revealed ventriculitis with brain infarction. After antimicrobial therapy was started, his consciousness level improved. Ventriculitis should be suspected when disturbance of consciousness continues longer than we predict after emergent arch aneurysm surgery. Delay in diagnosis can lead to a life-threatening condition.