Lessons of the month: Cerebrospinal Fluid Leak-associated Ventriculitis - a case report

We present a case of a 74-year-old woman with headaches, pyrexia, and intermittent right-sided otorrhoea and rhinorrhoea. Her nasal discharge tested positive for Beta-2-Transferrin, confirming a cerebrospinal fluid (CSF) leak. High-resolution CT (HRCT) mastoids showed a defect in the right tegmen, and CSF within the middle ear and mastoid air cells. A gadolinium-enhanced MRI brain showed high signal in the occipital horns of the lateral ventricles with Diffusion-Weighted Imaging (DWI) and a low signal with DWI-Apparent Diffusion Coefficient (DWI-ADC), consistent with ventriculitis. She made an uneventful recovery after with six weeks of intravenous antibiotics. The patient had surgical repair of bony defects to prevent recurrence. This highlights a rare case of ventriculitis associated with a spontaneous CSF leak, with no existing set diagnostic criteria, and high mortality. High clinical suspicion aided by appropriate imaging, and a multidisciplinary approach to management is imperative.