Trapped fourth ventricle in coccidioidal meningitis

Area of Science:

• Pediatric Neurology
• Infectious Diseases
• Neurosurgery

Background:

• Coccidioidal meningitis is a serious fungal infection affecting the central nervous system.
• Posterior fossa signs in children can indicate obstructive hydrocephalus.

Observation:

• A 4-year-old girl with coccidioidal meningitis presented with posterior fossa signs.
• CT imaging showed a large fourth ventricle with contrast flow obstruction.
• Symptoms resolved after surgical shunting of the fourth ventricle.

Findings:

• Contrast studies indicated a blockage at the aqueduct of Sylvius, preventing flow to the third ventricle.
• The obstruction was hypothesized to be a one-way valve caused by inflammation from meningitis.

Implications:

• This case highlights a potential complication of coccidioidal meningitis leading to hydrocephalus.
• Prompt diagnosis and surgical intervention, such as shunting, can effectively manage obstructive hydrocephalus.
• Understanding inflammatory mechanisms is crucial for managing pediatric neurosurgical complications of fungal meningitis.