Brain abscess rupturing into the ventricles or subarachnoid space

Fulminant ependymitis following intraventricular rupture of brain abscess

“…Proximity to the ventricles and abscess size appear to be critical factors that are predictive of intraventricular rupture [1][2][3]. In many cases of intraventricular brain abscess rupture, secondary ventriculitis accounts for the poor prognosis [4][5][6].…”

“…In many cases of intraventricular brain abscess rupture, secondary ventriculitis accounts for the poor prognosis [4][5][6]. Preemptive surgical intervention to prevent rupture has been advocated for patients with large brain abscesses in close proximity to the cerebral ventricles [1][2][3]8]. Our patient initially received conservative management because of concomitant meningitis [9].…”

“…Target CSF concentrations of VCM are 5-10 mg/L for the peak and \2 mg/L for the trough [10]. Recently, the mortality rate of patients with intraventricular rupture has declined to 30-50%, compared to a rate of 60-80% in the past [1][2][3][4][5][6].…”

“…Intraventricular rupture of brain abscesses, which reportedly occurs in 27-35% of cases, is frequently associated with poor prognosis [1][2][3]. Evacuation of the abscess by ventriculostomy combined with intraventricular antibiotic administration has been reported to be efficacious in such circumstances [4][5][6].…”

MRI demonstration of unsuspected intraventricular rupture of pyogenic cerebral abscesses in patients being treated for meningitis

“…It manifests as abrupt, unexpected clinical deterioration, usually with signs and symptoms of acute meningitis [4,7]. Mortality from rupture of brain abscess into a CSF space is very high, ranging from 84 to 100% [4,5] as compared to 30.5% in brain abscesses without rupture into the ventricles or subarachnoid space [6]. Abscesses are more likely to rupture into the ventricles than into the subarachnoid space because capsule formation is more complete on their cortical side [8,9].…”