case_images: PMC10927178_01
case_images: Basal head computed tomography scan; red arrows indicate left thalamic nodular lesion; yellow arrows indicate high density cerebrospinal fluid inside the left ventricle.
case_images: SNI-15-57-g001.jpg
case_images: PMC10927178_01_SNI-15-57-g001.jpg
case_images: F1
case_images: Initial cranial computed tomography (CT) imaging identified a hypodense nodular lesion in the left thalamus suggestive of a neoplastic process or an abscess [Figure 1].
case_images: Brain MRI: A left thalamic abscess measuring approximately 2cm in maximum diameter, with characteristics consistent with an infectious process - hyperintensity on DWI, hypointensity on ADC, central necrosis, surrounding edema affecting the thalamus and midbrain tectum. Dense material within the left lateral ventricle (body, atrium, and occipital horn) and partially in the right lateral ventricle, the aqueduct of Sylvius, and the fourth ventricle. The upper (a) and middle (b) rows display MRI FLAIR sequences in sagittal, coronal, and axial slices. The lower row (c) presents images in DWI and ADC map axial slices. FLAIR: Fluid Attenuation Inversion Recovery, DWI: Diffusion Weighted Images, ADC: Apparent Diffusion Coefficent.
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case_images: F2
case_images: The MRI confirmed a left thalamic abscess with a direct rupture into the ventricular system, causing ventriculitis characterized by diffuse ependymal enhancement and dense intraventricular material [Figures 2 and 3].
case_images: Post-contrast brain magnetic resonance imaging revealing thalamic abscess with ring enhancement post-contrast, the red arrows show an apparent direct communication between the abscess and the floor of the left lateral ventricle, causing ventriculitis with diffuse ependymal enhancement.
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case_images: F3
case_images: The MRI confirmed a left thalamic abscess with a direct rupture into the ventricular system, causing ventriculitis characterized by diffuse ependymal enhancement and dense intraventricular material [Figures 2 and 3].
case_images: Stereotactic planning using a pc-generated 3D virtual model representing ventricles and abscess and showing the planned trajectory. Panel a: 3D virtual model; Panels b, c, d: pos-contrast T1 weighted MRI, axial, coronal and sagittal slices with superimposed reconstruction of abscess and ventricles and planned stereotactic trajectory.
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case_images: F4
case_images: Preoperative planning involved a 3D virtual model to strategize the stereotactic approach to the abscess and possible EVD placement [Figure 4].
case_images: Panel a: Post-operative cranial CT scan (axial slices) demonstrating the accurate placement of the catheter tip within the abscess cavity, which exhibits reduced density. Panel b: 3D representation showing the ventricles, the abscess, and the catheter in situ.
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case_images: PMC10927178_01_SNI-15-57-g005.jpg
case_images: F5
case_images: Postoperative CT confirmed the reduction of the abscess and optimal placement of the catheter [Figure 5].
case_images: Post-operative MRI performed 9 days following surgery, depicting a reduction in the size of the brain abscess and ventricular dimensions, a decrease in edema, and an almost complete regression of ventriculitis. Upper row (a): Fluid Attenuation Inversion Recovery (FLAIR) sequences in sagittal, coronal and axial slices; lower row (b): post-contrast T1 weighted MRI in sagittal, coronal and axial slices. FLAIR: Fluid Attenuation Inversion Recovery.
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case_images: PMC10927178_01_SNI-15-57-g006.jpg
case_images: F6
case_images: A subsequent CT indicated a slight dislocation; an MRI of the brain confirmed the well-drained abscess and reduction in ventricular size with a marked decrease in ventriculitis, diminished intraventricular purulent material, and disappearance of transependymal resorption [Figure 6].