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

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Apr 19, 2023 29 likes •130 views

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

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McMaster University & Hamilton Health Sciences Department of Radiology Hamilton, ON mallory.granholm@medportal.ca

A Case Series Review of Cerebritis, Abscess and Ventriculitis

Dr. Mallory Granholm, MD, MPH & Dr. Milita Ramonas, MD, FRCPC

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Declaration of Conflict of Interest

 We do not have a relationship with a for-profit

and / or a not-for profit organization to disclose

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 Clinical History is KEY (but can be non-specific)  This process follows a (predictable) spectrum  Classic Abscess: ring enhancement, T2 hypo capsule, restricted diffusion  Beware of ventriculitis (high mortality)

Acute Cerebral Pyogenic Infection

The Highlights

Early Late

Cerebritis

Early Late

Abscess Pyogenic Ventriculitis

 Understanding of the spectrum and complications of acute pyogenic infection will aid the radiologist to make a timely diagnosis in this acute disease that carries high mortality

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Case 3

 Indication:

 54-year-old female, overdose on Eliquis, decreased level

f awareness, rule out bleed

 Additional provided history indicated headache, fever,

cough, increased sputum

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Case 3

 Initial CT Head C-

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(late abscess/pyogenic ventriculitis)

= ruptured abscess + ventriculitis

Case 3

 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 (←)

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Case 3

 MRI Brain (18h later)

(late abscess/pyogenic ventriculitis)

= ruptured abscess + ventriculitis

T2 FLAIR T1 w/GAD DWI ADC

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 MRI Brain (18h later)  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)

= ruptured abscess + ventriculitis

Case 3

T2 FLAIR T1 w/GAD DWI ADC

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 MRI Brain (POD #14, shunt fluid + Streptococcus anginosis)

Unfortunately, the patient expired 10 days later

Case 3

T2 FLAR T1 w/GAD DWI ADC

(late abscess/pyogenic ventriculitis)

= ruptured abscesses + ventriculitis

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References

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Brant, W., & Helms, C. (2012). Fundamentals of diagnostic radiology. Wolters Kluwer/Lippincott Williams & Wilkins.

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Forbes, K., Pipe, J., & Heiserman, J. (2001, 3 1). Evidence for cytotoxic edema in the pathogenesis of cerebral venous infarction. AJNR. American journal of neuroradiology, 22(3), 450-5.

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Hong, J., Son, B., Sung, J., Kim, I., Yang, S., Lee, S., & Park, C. (2008, 2). Significance of diffusion-weighted imaging and apparent diffusion coefficient maps for the evaluation of pyogenic ventriculitis. Clinical neurology and neurosurgery, 110(2), 137-44.

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Jorens, P., Voormolen, M., Robert, D., & Parizel, P. (2009, 12 18). Imaging Findings in Pyogenic

Ventriculitis. Neurocritical Care, 11(3), 403-405.

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Kanazawa, M., Wakasugi, N., Hatakeyama, M., Shimohata, T., & Nishizawa, M. (2015, 10 15). Fluid–fluid levels in lateral ventricles predict bacterial CNS infections. Journal of the Neurological Sciences, 357(1-2), 292-294.

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Lee, G., Antelo, F., & Mlikotic, A. (2009, 7 1). Cerebral Toxoplasmosis. RadioGraphics, 29(4), 1200-1205.

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Raibagkar, P., Neagu, M., Lyons, J., & Klein, J. (2014, 12 28). Imaging in Neurologic Infections I: Bacterial and Parasitic Diseases. Current Infectious Disease Reports, 16(12), 443.

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Vachha, B., Moonis, G., & Holodny, A. (2017, 1). Infections of the Brain and Meninges. Seminars in Roentgenology, 52(1), 2-9.