Cerebritis, Abscess and Ventriculitis Dr. Mallory Granholm, MD, MPH - PowerPoint PPT Presentation

A Case Series Review of Cerebritis, Abscess and Ventriculitis Dr. Mallory Granholm, MD, MPH & Dr. Milita Ramonas, MD, FRCPC McMaster University & Hamilton Health Sciences Department of Radiology Hamilton, ON mallory.granholm@medportal.ca

Declaration of Conflict of Interest  We do not have a relationship with a for-profit and / or a not-for profit organization to disclose

Acute Cerebral Pyogenic Infection The Highlights  Clinical History is KEY (but can be non-specific)  This process follows a (predictable) spectrum Pyogenic Early Late Early Late Cerebritis Abscess Ventriculitis  Classic Abscess: ring enhancement, T2 hypo capsule, restricted diffusion  Understanding of the spectrum and complications of acute pyogenic infection will aid the  Beware of ventriculitis (high mortality) radiologist to make a timely diagnosis in this acute disease that carries high mortality

Case 3  Indication:  54-year-old female, overdose on Eliquis, decreased level of awareness, rule out bleed  Additional provided history indicated headache, fever, cough, increased sputum

Case 3  Initial CT Head C-

(late abscess/pyogenic ventriculitis) Case 3 = ruptured abscess + ventriculitis  Initial CT Head C-  Findings  Two hypodense frontal lobe lesions with peripheral rind of hyperdensity ( ↓ )  Varying surrounding vasogenic edema  One abuts the ventricle with focal discontinuity ( ↓ )  Irregular ventricular debris layering dependently ( ← )

(late abscess/pyogenic ventriculitis) Case 3 = ruptured abscess + ventriculitis  MRI Brain (18h later) T2 FLAIR T1 w/GAD DWI ADC

(late abscess/pyogenic ventriculitis) Case 3 = ruptured abscess + ventriculitis  MRI Brain (18h later) T2 FLAIR T1 w/GAD DWI ADC  Findings  Peripherally enhancing ( ↓ ) centrally restricting lesion (abscess, ↓ ), which communicates with the ventricle (rupture and decompression) with extensive amount of restricting material in the intraventricular system (pus , ← )  Enhancement of ependyma (ventriculitis), hydrocephalus  Significant surrounding T2 hyperintensity (vasogenic edema)

(late abscess/pyogenic ventriculitis) Case 3 = ruptured abscesses + ventriculitis  MRI Brain (POD #14, shunt fluid + Streptococcus anginosis ) T2 FLAR T1 w/GAD DWI ADC Unfortunately, the patient expired 10 days later

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