PMC8418177_01
PMC8418177_02
mid-anterior ultrasound scans showing a moderate ventriculomegaly (yellow arrows) with abnormally large lateral ventricles (especially ventricular atrium and occipital horns; lateral ventricular diameter between 12-15 mm) and the third ventricle; the scans were performed using 7.5 MHz transducer through anterior fontanelle approach; note the absence of low-level internal echoes that are consistent with debris/pus within the ventricles
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F1
Transfontanellar ultrasound using 7.5 MHz transducer showed moderate ventriculomegaly (lateral ventricular diameter between 12-15mm) (Figure 1).
full body magnetic resonance imaging scan at presentation: (A, B) axial T1-weighted image and coronal T2-weighted image showing hydrocephalus; C) sagittal T2-weighted image showing downward displacement of the cerebellar tonsils beneath the foramen magnum into the cervical spinal canal (type I chiari malformation; yellow arrow) as well as a cervico-dorsal syrinx (white arrow) C7 to D5; D) sagittal full body scan showing lumbosacral myelomeningocele (red arrow)
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F2
Spinal cord imaging showed an extensive cervico-dorsal syrinx from C7 to D5 and lumbosacral myelomeningocele with low-lying spinal cord (Figure 2).
A) growth of Achromobacter xylosoxidans seen after 24 hours of incubation at 37 C on blood agar and chocolate agar plates, the colonies are smooth, glistening, low convex and non-lactose fermenting; B) classic gram stain image showing gram-negative Achromobacter xylosoxidans (blue arrow) with neutrophils (black arrow)
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F3
The concerned bacterium was identified using classic Gram stain showing a Gram-negative bacillus, oxidase + and catalase + concluding to a multi-resistant agent: Achromobacter Xylosoxidans (AX) (Figure 3).
head CT scan slides at different time points following ventricular drainage: A) axial CT slide (brain window) showing hydrocephalus; (B,C,D) axial CT scan slides (brain window) 2 weeks (with biparietal subdural hygroma; yellow arrows), 3 weeks (without biparietal subdural hygroma) and 5 weeks (relocation of subdural hygroma; yellow arrows) after right external ventricular drainage (blue arrow); E) axial CT scan slide (brain window) showing the new left external ventricular drainage; F) axial CT scan slide (brain window) 2 days after ventriculoperitoneal shunt in the left atrium (red arrow) and before the discharge of the infant
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F4
Follow-up and outcomes: follow-up computed tomography (CT) scans were performed weekly to assess hydrocephalus and the catheter s placement (Figure 4). The latest CT scan showed a decreased ventricular dilatation (Figure 4D).