PMC6042469_01
Computed tomography imaging before and after admission (A). The patient underwent hematoma removal from the cerebellum and decompression in a local medical facility. Computed tomography after admission to our hospital revealed cerebellar hemorrhage in the bilateral and 3rd ventricles (B). We temporarily placed a bilateral ventricular drainage in the occipital horns after the clearance of abscess on a ventriculoscope on November 3, 2017 (C). We replaced the bilateral ventricular drainage in the frontal horns due to CSF leakage in the occipital horns on November 14, 2017.
fneur-09-00518-g0001.jpg
PMC6042469_01_fneur-09-00518-g0001.jpg
F1
CT indicated cerebellar hemorrhage in the bilateral and 3rd ventricles (Figure 1). CSF from EVD revealed a white blood cell count of 1,280 x 106/L, total protein 4.18 g/L, and glucose 2.26 mmol/L, the simultaneous blood glucose level was 7.5 mmol/L (Table 3). An endoscopic ventriculostomy was done, a large amount of pus was removed from the ventricles (Figure 3), and two EVDs were placed for antibiotic therapy (bilateral occipital horn; Figure 1). Therefore, on November 14, 2017, we removed the two occipital horn drainage tubes and replaced it with two frontal horn drainage tubes with a bigger size (12#) and a longer subcutaneous tunneling (10 cm) (Figure 1).
Brain MRI obtained before (A) and after (B) abscess clearance combined with tigecycline treatment (A). MRI on October 31, 2017 showed that interstitial cerebral edemas beside the ventricles and bilateral ventricular occipital horn enhancement along with hydrocephalus, which indicated signs of ventriculitis (B). MRI after abscess clearance combined with tigecycline treatment revealed the disappearance of the edemas, ventricular enhancement, and hydrocephalus.
fneur-09-00518-g0002.jpg
PMC6042469_01_fneur-09-00518-g0002.jpg
F2
In addition, occipital horn enhancement bilaterally suggested intracranial infection (Figure 2). The follow-up MRI (November 27, 2017) was negative for ventriculitis (Figure 2).
Abscess clearance on a ventriculoscope. Large amount of cellulose deposition in the ventricles were observed on a ventriculoscope, and the lesion was infected, which needed neurosurgery.
fneur-09-00518-g0003.jpg
PMC6042469_01_fneur-09-00518-g0003.jpg
F3
An endoscopic ventriculostomy was done, a large amount of pus was removed from the ventricles (Figure 3), and two EVDs were placed for antibiotic therapy (bilateral occipital horn; Figure 1).