Ventriculitis
Updates to Article Attributes
Ventriculitis refers to inflammation, usually due to infection, of the ependymal lining of the cerebral ventricles. It is most often due to intraventricular rupture of brain abscess.
Epidemiology
Its epidemiology is varied and depends on the underlying cause.
- meningitis (both pyogenic and viral): most common
- cerebral abscess
- shunt/EVD related
- trauma
Pathology
Meningitis is the most common underlying condition responsible for the ventriculitis. It is directly related to lower host immunity and higher virulence of the causative organism. The occurrance of direct haematogenous spread to the choroid plexus has also been suggested. In long standing cases (>2 months) ventricular septations develop which result in compartmentalization and multiloculated hydrocephalus hydrocephalus and makes prognosis worse.
Radiographic features
CT
Non-contrast CT of the brain usually demonstrates only non-specific features, most frequently hyperdense layering material may be seen dependently, particularly in the occipital horns of the lateral ventricles 1.
Hydrocephalus and periventricular low density (which probably represents reactive oedema rather than transependymal oedema related to hydrocephalus 1) is also frequently present, as of course may the features of the underlying abnormality (e.g. meningitis, shunt / EVD/EVD, trauma)
Following administration of contrast, thin regular enhancement of the ependymal lining of the ventricles may be seen.
MRI
MRI demonstrates the same features as CT, with layering debris in the occipital horns frequently seen. There often is intense restricted diffusion of these intraventricular debris, as seen in the center of a brain abscess.
MRI is also more sensitive to the often subtle periventricular abnormal signal (high T2) and thin contrast enhancement.
Additionally, the periventricular region may demonstrate restricted diffusion on DWI / ADC.
Differential diagnosis
The main differential diagnosis is that of ependymal lining enhancement, which includes epndymalependymal spreading of glioblastoma multiforme or primary CNS lymphoma. In these cases, the enhancement is, usually, bumpy / nodular/nodular. Extracrania neplasmlExtracranial neoplasm metastases and germinoma may also be responsible for similar findings.
-<a href="/articles/leptomeningitis">meningitis</a> (both pyogenic and viral) : most common</li>- +<a href="/articles/leptomeningitis">meningitis</a> (both pyogenic and viral): most common</li>
-</ul><h4>Pathology</h4><p>Meningitis is the most common underlying condition responsible for the ventriculitis. It is directly related to lower host immunity and higher virulence of the causative organism. The occurrance of direct haematogenous spread to the choroid plexus has also been suggested. In long standing cases (>2 months) ventricular septations develop which result in compartmentalization and multiloculated <a href="/articles/obstructive-hydrocephalus">hydrocephalus</a> hydrocephalus and makes prognosis worse.</p><h4>Radiographic features</h4><h5>CT</h5><p>Non-contrast CT of the brain usually demonstrates only non-specific features, most frequently hyperdense layering material may be seen dependently, particularly in the occipital horns of the <a href="/articles/lateral-ventricles">lateral ventricles</a> <sup>1</sup>.</p><p>Hydrocephalus and periventricular low density (which probably represents reactive oedema rather than <a href="/articles/transependymal-oedema">transependymal oedema</a> related to hydrocephalus <sup>1</sup>) is also frequently present, as of course may the features of the underlying abnormality (e.g. meningitis, shunt / EVD, trauma) </p><p>Following administration of contrast, thin regular enhancement of the ependymal lining of the ventricles may be seen. </p><h5>MRI</h5><p>MRI demonstrates the same features as CT, with layering debris in the occipital horns frequently seen. There often is intense restricted diffusion of these intraventricular debris, as seen in the center of a brain abscess.</p><p>MRI is also more sensitive to the often subtle periventricular abnormal signal (high T2) and thin contrast enhancement. </p><p>Additionally, the periventricular region may demonstrate restricted diffusion on DWI / ADC.</p><h4>Differential diagnosis</h4><p>The main differential diagnosis is that of ependymal lining enhancement, which includes epndymal spreading of <a href="/articles/glioblastoma">glioblastoma multiforme</a> or <a href="/articles/primary-cns-lymphoma">primary CNS lymphoma</a>. In these cases, the enhancement is usually bumpy / nodular. Extracrania neplasml metastases and <a href="/articles/germinoma">germinoma</a> may also be responsible for similar findings.</p>- +</ul><h4>Pathology</h4><p>Meningitis is the most common underlying condition responsible for the ventriculitis. It is directly related to lower host immunity and higher virulence of the causative organism. The occurrance of direct haematogenous spread to the choroid plexus has also been suggested. In long standing cases (>2 months) ventricular septations develop which result in compartmentalization and multiloculated <a href="/articles/obstructive-hydrocephalus">hydrocephalus</a> hydrocephalus and makes prognosis worse.</p><h4>Radiographic features</h4><h5>CT</h5><p>Non-contrast CT of the brain usually demonstrates only non-specific features, most frequently hyperdense layering material may be seen dependently, particularly in the occipital horns of the <a href="/articles/lateral-ventricles">lateral ventricles</a> <sup>1</sup>.</p><p>Hydrocephalus and periventricular low density (which probably represents reactive oedema rather than <a href="/articles/transependymal-oedema">transependymal oedema</a> related to hydrocephalus <sup>1</sup>) is also frequently present, as of course may the features of the underlying abnormality (e.g. meningitis, shunt/EVD, trauma) </p><p>Following administration of contrast, thin regular enhancement of the ependymal lining of the ventricles may be seen. </p><h5>MRI</h5><p>MRI demonstrates the same features as CT, with layering debris in the occipital horns frequently seen. There often is intense restricted diffusion of these intraventricular debris, as seen in the center of a brain abscess.</p><p>MRI is also more sensitive to the often subtle periventricular abnormal signal (high T2) and thin contrast enhancement. </p><p>Additionally, the periventricular region may demonstrate restricted diffusion on DWI / ADC.</p><h4>Differential diagnosis</h4><p>The main differential diagnosis is that of ependymal lining enhancement, which includes ependymal spreading of <a href="/articles/glioblastoma">glioblastoma multiforme</a> or <a href="/articles/primary-cns-lymphoma">primary CNS lymphoma</a>. In these cases, the enhancement is, usually, bumpy/nodular. Extracranial neoplasm metastases and <a href="/articles/germinoma">germinoma</a> may also be responsible for similar findings.</p>
Image 1 CT (C+ delayed) ( update )
Image 2 MRI (DWI) ( update )
Image 3 MRI (T1 C+) ( update )
Unable to process the form. Check for errors and try again.