case_images: PMC11344898_01
case_images: The figure above shows severe communicating hydrocephalus present within the lateral ventricles.. Figure 1a shows the bi-frontal diameter is measured at 46 mm, whereas Figure 1b and 1c depict both the left and right temporal horn to be approximately 16 mm. There is no evidence of bleed, infarction, fracture, or mass.. The figure above shows severe communicating hydrocephalus present within the third and fourth ventricles with normal gray-white matter differentiation with no evidence of bleed, fracture, infarction, or mass. Figure 1d shows the third ventricle to be measured at 22 mm, and Figure 1e depicts the fourth ventricle is measured to be 28 x 18 mm.
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case_images: CT (Computed Tomography) scan results were pending. CSF (Cerebrospinal fluid) cultures were negative but coccidiomycosis blood titers show weakly reactive IgM and strong IgG response with a titer of 1:128, indicating that the patient has a history of coccidiomycosis with a current active infection. CT scan demonstrated enlargement of the ventricles with periventricular edema most likely secondary to increased CSF with no evidence of infarction, trauma, hemorrhage, or mass (Figure 1).
case_images: This CT head without contrast shows there is interval placement of the right frontal VP shunt catheter with the tip placed in the left lateral ventricle with no signs of hemorrhage.
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case_images: He was transfused 2 units of platelets, given perioperative vancomycin, and a VP shunt was placed (Figure 2).
case_images: The lateral ventricles in this coronal CT scan depict not only the VP shunt in place but also a decrease in size from the frontal horns currently measuring 38.4 mm when compared with 46.4 mm prior in Figure 1a.
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case_images: A repeat CT scan of the head without contrast (Figure 3) showed a decrease in ventricular prominence on the lateral ventricles.
case_images: The red circle shows increasing right frontal lobe hypoattenuation with questionable collection surrounding the ventriculostomy catheter.
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case_images: CT without contrast was done showing worsening right frontal hypodensity with a questionable collection surrounding the ventriculostomy catheter with concerns for abscess resulting in catheter failure (Figure 4). CT scan also re-demonstrated re-accumulation of CSF.
case_images: The MRI of the brain shows that there is a large area of vasogenic edema in the superior right frontal lobe measuring at approximately 63 x 37 mm. At the center of the edema, there is a ring-like enhancing lesion with a thick wall slightly thinner on the medial aspect suggesting an abscess.
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case_images: MRI showed an abscess measuring 27 x 17 mm surrounding the shunt path and metronidazole 500 mg 3 times daily was added due to the likely intra-abdominal source of the pathogen (Figure 5).
case_images: This CT of the head portrays gas in the lateral ventricle in the frontal horns.
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case_images: Another CT scan of the head without contrast was done which showed moderately severe hydrocephalus with gas in the lateral ventricles, particularly in the frontal horns (Figure 6).