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BMJ Case Reports 2017; doi:10.1136/bcr-2017-221849
  • Unusual presentation of more common disease/injury
  • CASE REPORT

Subclinical meningoventriculitis as a cause of obstructive hydrocephalus

  1. Shailendra Magdum2
  1. 1Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK
  2. 2Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
  3. 3Department of Paediatric Infectious Diseases and Immunology/Oxford Vaccine Group, University of Oxford, Oxford, UK
  1. Correspondence to Ravindran Visagan, visagan{at}doctors.org.uk
  • Accepted 28 September 2017
  • Published 11 October 2017

Summary

Communicating hydrocephalus may complicate infantile bacterial meningitis, typically presenting with systemic features of infection. We report a rare case of ‘subclinical meningoventriculitis’ causing obstructive hydrocephalus and its challenging management. A healthy 10-week-old immunocompetent male patient presented with failure to thrive and vomiting, secondary to presumed gastro-oesophageal reflux. The child was neurologically alert, afebrile with normal inflammatory markers. Progressive macrocephaly prompted an MRI confirming triventricular hydrocephalus secondary to aqueductal stenosis. An endoscopic third ventriculostomy was performed however abandoned intraoperatively due to the unexpected finding of intraventricular purulent cerebrospinal fluid. A 6-week course of intravenous ceftriaxone was commenced for Escherichia coli meningoventriculitis. However, the child was readmitted 18 days postoperatively with acute hydrocephalus requiring a ventricular washout and staged ventriculoperitoneal shunt insertion at 4 weeks. Serial head circumference measurements are paramount in the assessment of a paediatric patient. In an immunocompetent child, a subclinical fibropurulent meningoventriculitis can result in several management challenges.

Footnotes

  • Contributors RV and LJL obtained the clinical details and prepared the manuscript with DK and SM providing further expert review and revision of the manuscript.

  • Competing interests None declared.

  • Patient consent Guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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