Case-based update: primary intraventricular brain abscess in a 10-year-old child.
BACKGROUND
Intraventricular abscesses are very rare and usually result from secondary rupture of a brain abscess. In the few published cases, clinical presentation was subacute and different pathogens were found. The diagnosis might be mistaken as an intraventricular tumor.


METHODS
This is a case of a 10-year-old girl suffering from cyanotic heart disease that was presented with subacute onset of headache, vomiting, and some signs of inflammation. Symptoms lead to early brain imaging (CT/MRI) demonstrating left ventricular horn lesion affecting adjacent brain structures. Neuroradiologists suspected an intraventricular tumor, but cardiac history and signs of inflammation led to lumbar puncture and evidence of CNS infection, and intraventricular abscess was suspected. Navigated aspiration was performed, and multi-sensitive Eikenella corrodens was cultivated. Broad antibiotic treatment and dexamethasone were initiated, and symptoms disappeared. Follow-up imaging demonstrated gradual regression of the intraventricular abscess. The girl underwent regular professional teeth cleaning which was discussed as possible cause of infection.


CONCLUSIONS
Although an isolated intraventricular abscess is a very rare event, typical predisposing cardiac history together with central nervous symptoms and an intracranial contrasting mass should always lead to the differential diagnosis of a brain abscess and be biopsied first. E. corrodens is a typical organism of the mouth flora, but a rare cause for a brain abscess. Harmless teeth cleaning procedures may cause hematogenic spread and lead to CNS infections, e.g., in patients with predisposing diseases. To our knowledge, there are only six previous reports of primary intraventricular brain abscess.
Servicio de Neurocirugía, Hospital Universitario de León, León, Spain.
Patricia Barrio
PB
Fernández
Servicio de Neurocirugía, Hospital Universitario de León, León, Spain.
Javier Pérez
JP
Suárez
Abteilung für Pädiatrische Neurochirurgie, Asklepios Klinik, Arnold-Janssen-Str. 29, 53757, Sankt Augustin, Germany. m.messing@asklepios.com.
A Martina
AM
Messing-Jünger
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000175:diagnosis* / Q000188:drug therapy; D002552:Cerebral Ventricles / Q000473:pathology*; D002648:Child; D019468:Disease Management; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents
Cyanotic heart disease; Eikenella corrodens; Intraventricular brain abscess