What Is Ventriculitis?

Ventriculitis (ventriculitis), also known as ventriculitis, is inflammation that occurs in and around the ventricle system. Generally, it is caused by bacterial invasion to the ventricle after traumatic brain injury or surgery (especially long-term extraventricular drainage). It is characterized by purulent changes in the cerebrospinal fluid of the ventricle. Ventriculitis is a fatal intracranial infection in neurosurgery. The mortality rate of patients is very high, and the mortality rate of intraventricular empyema is particularly high.

Basic Information

nickname

Ventricular meningitis

English name

Cerebral Ventriculitis

Visiting department

Neurology

Common causes

Caused by bacterial invasion into the ventricle after traumatic brain injury or surgery

Common symptoms

Mild patients have headaches and stiff necks; severe patients have acute illness, high fever, delirium, coma, and even cerebral hernia

Causes of ventricular inflammation

1. bacterial invasion caused by brain injury

It is mainly seen in penetrating brain injury, especially those with incomplete debridement at early stage of ventricular penetrating injury.

2. Infection in other parts of the skull spread to the ventricle

Such as secondary to purulent meningitis, brain abscess, subdural empyema, etc., abscess ulceration or bacteria invade the ventricle.

3. Nosocomial infection

Craniocerebral surgery, especially after ventricular hemorrhage or ventricular tumors, is prone to occur, especially those caused by excessive extraventricular drainage or catheter bypass surgery.

4. Pathogenic bacteria

Usually the pathogenic bacteria are Staphylococcus, Gram-negative bacilli, Pseudomonas aeruginosa or anaerobic bacteria.

5. Risk factors

(1) The primary pollution is severe when the brain is injured.

(2) Incomplete debridement after head injury.

(3) Residual foreign bodies in the skull.

(4) Insufficient scalp preparation or aseptic conditions before craniocerebral surgery.

(5) Contamination during surgery.

(6) The postoperative catheterization time is too long, such as> 2 weeks.

(7) Improper intraventricular injection or irrigation.

(8) The concept of replacing the drainage bottle is not strong, causing pollution.

(9) The direct spread or rupture of a brain abscess adjacent to the ventricle.

(10) Purulent meningitis is not treated in a timely and regular manner.

Ventriculitis clinical manifestations

1. Mild ventricular inflammation is similar to meningitis, with headache, neck stiffness, etc., and it is often ignored in the early stage.

2. Severe ventricular inflammation has rapid onset, often with high fever, delirium, coma, and changes in vital signs, and even causes hernia.

3. Patients with ventricular inflammation caused by cerebral abscess breaking into the ventricle often have dilated pupils, lower blood pressure, and respiratory failure.

4. Abscesses close to the ventricle wall due to the inflammatory reaction or small leakage of pus can cause local intracerebroventricular periventricular inflammatory infiltration, intraventricular adhesions and diaphragm formation, causing hydrocephalus and intracerebral infectious compartments The corresponding clinical manifestations appear.

Ventriculitis examination

Lumbar puncture cerebrospinal fluid examination

As the main diagnostic basis of ventricular inflammation, it can be seen that increased cerebrospinal fluid pressure, increased white blood cells, pus bulbs, flocculent purulent secretions, increased protein content, and reduced sugar content, especially positive bacterial culture can be used as a direct diagnostic basis.

2. Blood routine and blood culture

Leukocytes and neutrophils can increase, and sometimes positive bacteria can be cultured.

3. CT scan of the head

Ventricular ventricular membranes are localized or diffuse thin layer of linear enhancement, intraventricular adhesions appear as separate reinforced foci, hydrocephalus or ventricular deformation and expansion. Can also be found in the lesions complicated by ventricular inflammation, such as meningitis, brain abscess, cerebral edema and softening.

4. Skull MRI

In severe cases, T ₂ images can be seen in the white matter around the ventricle with a band of high-signal areas surrounding the ventricle. Can also be found in the lesions complicated by ventricular inflammation, such as meningitis, brain abscess, cerebral edema and softening.

Ventriculitis diagnosis

1. The clinical symptoms of suppurative ventriculitis are mostly non-specific. Those with the following conditions should consider the possibility of ventricular inflammation:

(1) Irregular fever several days after open brain injury.

(2) Headache, neck rigidity, delirium or conscious disturbance occurred during anti-infective treatment 3 to 5 days after craniotomy.

(3) The operative site gradually bulges and the wound is purulent. After anti-infection and dehydration treatment, the symptoms are difficult to relieve.

2. The above typical clinical manifestations.

3. Positive findings of cerebrospinal fluid examination.

4. Typical performance of CT or MRI enhanced scan of the head.

Ventriculitis complications

The disease is prone to complications such as cerebral hernia, ventricular empyema, and hydrocephalus. The condition often changes rapidly and the mortality rate is high.

Ventriculitis treatment

1. The treatment of ventriculitis is still a difficult problem. Once the disease occurs, it is necessary to continue the irrigation and drainage of the ventricle catheter, cooperate with systemic medication, and actively treat the cause.

2. Generally, the pathogenic bacteria should be identified as soon as possible through lumbar puncture or ventricular puncture of cerebrospinal fluid drainage, and antibiotics that are sensitive and can penetrate the blood-brain barrier should be selected according to the results of drug sensitivity tests.

3. Advantages of continuous irrigation and drainage of ventricle catheters: maintain effective drug concentration in the ventricle and subarachnoid space, and the effect is continuous; continuous external drainage can reduce intracranial pressure, and flush and drain inflammatory substances and proteins to reduce toxins Response to prevent arachnoid inflammatory adhesions; cerebrospinal fluid samples can be taken at any time for testing and guide treatment.

4. If the infection is caused by too long drainage time, the drainage tube or shunt tube previously placed in the ventricle should be removed immediately, and the drainage tube should be repositioned on the contralateral side, and the lumbar spinal tube drainage should be performed at the same time if necessary.

5. If the ventricle system is blocked or the sensitive drug of the drug sensitivity test passes through the blood-brain barrier, it should be repeatedly administered through the ventricle puncture and drainage during the systemic administration and intraventricular administration. If necessary, double-tube irrigation and drainage should be performed. After the drainage solution has cleared, the symptoms have improved, the bacterial culture is negative, and the white blood cell count is normal, you can remove the tube.

6. Abscesses located in the deep part of the brain close to the ventricle. If necessary, an emergency craniotomy is required to remove the abscess. The ventricle is thoroughly flushed with antibacterial saline.