Pyogenic ventriculitis: Magnetic resonance imaging (MRI) findings in two cases.

Abstract

Learning objectives: This poster aimed to highlight the MRI findings of pyogenic ventriculitis that may appear relatively subtle on Computed Tomography (CT) scan. Background: Pyogenic ventriculitis is an uncommon severe intracranial infection that most often occurs as a complication of a brain abscess ruptures into the ventricles but rarely may result from the extension of meningitis, or a neurosurgical procedure or device. Its symptoms and signs may be subtle and its course can be indolent but lethal. Although ventriculitis has been well described on CT scan and ultrasound but the MRI findings of just a few adult cases have been yet described. Moreover, MRI is superior to CT scan in demonstrating the key features of this disease. The following two cases and a review of published articles are aimed at increasing the awareness of the existence of this condition and the importance of MRI in illustrating the characteristic Hallmarks of pyogenic ventriculitis. Imaging findings: In both cases, there were abnormal periventricular intensities on Fluid Attenuated Inversion Recovery (FLAIR) sequence and enhancement on contrast-enhanced T1-weighted MRI. Irregular Intraventricular debris which were demonstrated on both Diffusionweighted Imaging (DWI) and FLAIR sequences, projected as hypointensities in the dependent portions of lateral ventricles on T2-weighted images. DWI sequences provided better lesion contrast than FLAIR. Conclusion: Neuroimaging, especially MRI, is crucial in clearly depicting the pyogenic ventriculitis. Hence, it is important for radiologists to be aware of the specific MRI features of this life-threatening infective entity.<br />