title: Diffusion magnetic resonance imaging diagnostic relevance in pyogenic ventriculitis with an atypical presentation: a case report.
abstract: BACKGROUND
  Pyogenic ventriculitis is a rare and severe cerebral infection characterized by the presence of suppurative fluid in the cerebral ventricles. It is a life-threatening condition and may present with an aspecific neurological picture. Brain imaging techniques usually demonstrate intraventricular debris and pus, but negative imaging along with a misleading clinical picture may delay the diagnosis.
  
  
  METHODS
  The described patient underwent a number of surgical procedures and eventually developed an unusual clinical picture characterized by psychomotor slowing, facial dyskinesias and myoclonic jerks without complaint of headache and in absence of meningeal irritation signs or focal neurological deficits. Cerebrospinal fluid cultural examination showed methicillin-resistant Staphylococcus aureus and vancomycin treatment lead to a complete recovery. Brain computed tomography scan was normal, while only diffusion magnetic resonance imaging sequences were able to define the presence of purulent material within the brain lateral ventriculi.
  
  
  CONCLUSIONS
  The present case underlines the importance of taking into account the diagnosis of pyogenic ventriculitis even when the neurological picture does not match the suspect of a central nervous system infection. Moreover, brain computed tomography scan and standard magnetic resonance imaging sequences may be unable to confirm the diagnosis, whereas diffusion-weighted sequences prove a unique role in diagnosing cerebral pyogenic ventriculitis.
authors.affiliation: Institute of Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Largo Daneo 3, 16132 Genova, Italy. lucio.marinelli@unige.it.
authors.forename: Lucio
authors.initials: L
authors.lastname: Marinelli
authors.forename: Carlo
authors.initials: C
authors.lastname: Trompetto
authors.forename: Leonardo
authors.initials: L
authors.lastname: Cocito
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D058565:Cerebral Ventriculitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D020547:Lateral Ventricles / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000382:microbiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification / Q000502:physiology; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin