Abstract
Background
Ventriculitis, a dreaded complication of brain abscess, meningitis, and various neurosurgical procedures, has attracted limited attention in the medical literature.
Methods
Retrospective single-centre study. We screened medical files of all patients who had a brain imaging report including the word “ventriculitis” during years 2005-2019. Only patients with clinical, microbiological and imaging features of ventriculitis were included. Data were collected through a standardized questionnaire.
Results
Ninety-eight patients fulfilled inclusion criteria: 42 women and 56 men, median age 60 years [interquartile range 48-68]. Primary mechanism for ventriculitis was classified as follows: brain abscess (n=29, 29.6%), meningitis (n=27, 27.6%), intraventricular catheter-related (n=17, 17.3%), post-neurosurgery (n=13, 13.3%), and hematogenous (n=12, 12.2%). Main neuroimaging features were intraventricular pus (n=81, 82.7%), ependymal enhancement (n=70, 71.4%) and intraventricular loculations (n=15, 15.3%). Main pathogens were streptococci (n=44, 44.9%), Gram-negative bacilli (n=27, 27.6%), and staphylococci (n=15, 15.3%). In-hospital and one-year mortality rates were, respectively, 30.6% (n=30), and 38.8% (n=38). Neurological sequelae were reported in 34/55 (61.8%) survivors, including cognitive impairment (n=11), gait disturbances (n=9), paresis (n=7), behavior disorder (n=6), epilepsy (n=5). On multivariate analysis, age > 65 years, Glasgow Coma Scale score < 13 at initial presentation, status epilepticus, hydrocephalus and positive cerebrospinal fluid culture were associated with one-year mortality. We built a scoring system to stratify patients with ventriculitis into low-risk (12.5%), intermediate-risk (36.5%), and high-risk (71.4%) of death.
Conclusion
Ventriculitis is a severe complication of brain abscess, meningitis, or neurosurgery, with in-hospital mortality rate of 30%, and neurological sequelae in 60% of survivors.