PMC5180438_01
Case 1 - (a) and (b) Preoperative contrast-enhanced computed tomography (CECT) scan of the brain showing a right frontal abscess in close proximity to the frontal horn of the right lateral ventricle. The dotted line with closed arrow depicts the ependymal enhancement. The full line with closed arrow shows the "pus-fluid" level demonstrating debris in the dependent occipital horn. (c) Post-tapping CT showing air within the abscess cavity. (d and e) CECT scan during treatment showing the well-developed abscess wall communicating with the loculated right lateral ventricle. (f) Follow-up CECT shows resolution of the abscess and the ventriculitis
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F1
The "tell-tale" signs of IVROBA were ependymal enhancement seen in the right frontal horn [Figure 1a; dotted line with closed arrow head] and the presence of debris (pus) seen in the dependent right occipital horn, demonstrated by the pus-fluid level [Figure 1b; arrow with closed head]. Follow up imaging done at 3-months post discharge showed complete resolution of abscess and absence of ependymal enhancement [Figure 1f].
PMC5180438_02
(a) Preoperative contrast-enhanced computed tomography (CECT) scan of Case 2 shows a superficially located brain abscess in the right temporal lobe; abscess shows well-formed lateral wall and ill-formed medial wall, with the temporal horn of the lateral ventricle showing ependymal enhancement (dotted line with closed arrow head) and presence of debris (full line with closed arrow). (b) Post-operative CECT scan shows excision of the abscess. (c) CECT during treatment showing loculated right temporal horn. (d) Follow-up CT scan at 3 weeks after stopping antibiotics showing loculated ventricles with hydrocephalus, elevated bone flap, and raised intracranial pressure
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F2
The presence of ependymal enhancement of the right temporal horn [Figure 2a; dotted arrow with closed arrow head] and evidence of debris within the temporal horn ("fluid-pus level" indicated by the closed arrow head in Figure 2a) suggested IVROBA. Bone flap at the operative site was raised suggestive of raised intracranial pressure (ICP) [Figure 2d].
(a and b) Preoperative CECT scan of Case 3 shows a superficially located brain abscess in the left temporal lobe with clear-cut evidence of intraventricular rupture of brain abscess and debris in the dependent occipital horns (full line with closed arrow head). (c) Post-operative contrast-enhanced computed tomography (CECT) scan shows excision of the abscess and postlavage status of the ventricles. (d) CT scan done at 3 days after surgery reveals widespread patchy cerebral infarction secondary to septic arteritis
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F3
He was evaluated with CT head which showed a left posterior temporal abscess, with rupture into the temporal horn of the left lateral ventricle [Figure 3a and b]. CT brain (3 days after the surgery) showed multiple cerebral infarctions suggestive of septic arteritis [Figure 3d].