Diffusion-weighted magnetic resonance imaging demonstrating intraventricular rupture of a cerebral abscess and subsequent therapeutic response.
BACKGROUND
The most feared complication of a pyogenic brain abscess is intraventricular rupture. Mortality for this event has been traditionally reported to be approximately 80%. Appreciation of the incidence of IVROBA has likely increased with the dawn of CT and MRI. In selected cases, a patient with IVROBA may demonstrate a functional survival with low morbidity, if therapy is initiated quickly and aggressively.


METHODS
The authors report the IVROBA in a 49-year-old patient despite appropriate abscess drainage and broad-spectrum intravenous antibiotic administration. Diffusion-weighted MRI was particularly useful in this case for the demonstration of not only the intraventricular rupture but also the subsequent resolution of the inflammatory response within the ventricular system in response to aggressive ventricular drainage and systemic antibiotic therapy.


CONCLUSIONS
Diffusion-weighted MRI can be applicable both to the diagnosis of IVROBA as well as to the response to appropriate surgical therapy. With aggressive treatment, a good outcome is achievable in the setting of IVROBA.
Engh
Johnathan A
JA
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Mintz
Arlan
A
Kassam
Amin B
AB
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging; D004322:Drainage; D005260:Female; D006801:Humans; D020547:Lateral Ventricles; D008875:Middle Aged; D012422:Rupture, Spontaneous / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D013290:Streptococcal Infections / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery
D000900:Anti-Bacterial Agents