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Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation

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Cerebrospinal fluid leak-associated ventriculitis - a case report.

Amir Waheed¹, Faryal Amir²

¹Department of Acute & General Internal Medicine, Great Western Hospital, Marlborough Road, Swindon SN3 6BB, UK.

Clinical Medicine (London, England)

|December 20, 2024

Summary

A rare case of ventriculitis, an infection of the brain's ventricles, resulted from a spontaneous cerebrospinal fluid (CSF) leak. Prompt diagnosis and treatment with antibiotics and surgery led to recovery.

Keywords:

Beta-2-transferrin CSF leak Case report Ventriculitis

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Area of Science:

Neurology
Neurosurgery
Infectious Diseases

Background:

Cerebrospinal fluid (CSF) leaks can lead to serious intracranial infections.
Spontaneous CSF leaks, particularly those causing ventriculitis, are exceedingly rare and lack established diagnostic criteria.

Observation:

A 74-year-old woman presented with headache, fever, and unilateral ear/nasal discharge.
Nasal discharge tested positive for beta-2-transferrin, confirming a CSF leak.
Imaging revealed a tegmen defect, CSF in the middle ear/mastoid, and signs of ventriculitis on MRI.

Findings:

The patient was diagnosed with ventriculitis secondary to a spontaneous CSF leak.
Treatment involved 6 weeks of intravenous antibiotics and surgical repair of the bony defect.
The patient experienced an uneventful recovery, highlighting the importance of early intervention.

Implications:

This case underscores the need for high clinical suspicion for rare conditions like ventriculitis from spontaneous CSF leaks.
Multidisciplinary management and advanced imaging (HRCT, MRI with DWI) are crucial for diagnosis and treatment.
Despite high mortality associated with such cases, prompt and comprehensive care can lead to favorable outcomes.