Treatment of brain abscess rupturing into ventricle: a case report and literature review

Brain abscess is a focal intraparenchymal infection. Brain abscess breaking into ventricles is a potentially fatal complication of brain abscess, which can lead to sudden deterioration of neurological function. Its incidence rate is 0.3%-35.0%, and the mortality rate is 84.0%-100.0%. This paper reports a case of a 50-year-old male patient who had previously undergone intracranial hematoma evacuation and skull fixation for traumatic brain injury. He was admitted to the hospital with dizziness for 20 days and bradyphrenia for 4 days. After admission, enhanced computerized tomography(CT) and magnetic resonance imaging(MRI) indicated a left frontal lobe brain abscess. During empirical treatment with ceftriaxone and metronidazole, the abscess ruptured into the ventricle, leading to ventriculitis. Bilateral external ventricular drainage (EVD) combined with ventricular lavage was performed using stereotactic technology. Metagenomic next-generation sequencing (mNGS) of the pus identified the infecting bacteria as Parvimonas micra and Fusobacterium. According to clinical guidelines, the anti-infective regimen was adjusted, short-term low-dose methylprednisolone was used, and combined with hyperbaric oxygen therapy. The patient recovered and was discharged. This paper emphasizes that timely identification of brain abscess rupture leading to ventriculitis, adoption of bilateral external ventricular drainage combined with ventricular lavage, determination of abscess pathogens using mNGS technology, and selection of sensitive antibacterial drugs can improve the cure rate of ventriculitis.