Intraventricular Rupture of Brain Abscess (IVROBA).pdf

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L. Erin Miller, MD2, Teresa Crow, MD1, Troy Carnwath, MD1,
Scott DiMeo, MD1, Natalie Rall, MD1
Carolinas Medical Center & ...

Disclosures
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Neurosurgery Residency Programs at Ca...

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Andrew Asimos, MD, FACEP
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Case
A 49-Year-Old Male With No Known Medical History Presented To The ED
With Confusion And Agitation. Co-Worker Shared T...

STAT Head CT

→
STAT Head CT
• Ring-enhancing lesion
of the right temporal
lobe that abuts the
ventricles (→)

STAT Head CT
• Ring-enhancing lesion
of the right temporal
lobe that abuts the
ventricles (→)
• Hydrocephalus (⇒)
→

STAT Head CT
• Ring-enhancing lesion
of the right temporal
lobe that abuts the
ventricles (→)
• Hydrocephalus (⇒)
• Scatte...

STAT Head CT
• Ring-enhancing lesion
of the right temporal
lobe that abuts the
ventricles (→)
• Hydrocephalus (⇒)
• Scatte...

The Case Continues
After Returning From CT The Patient Became Progressively More Obtunded
And Had A Brief, Self-Terminatin...

Intraventricular Rupture Of Brain Abscess
The MRI T1 + C Views Demonstrate The Abscess Abutting Up Against The
Occipital H...

Intraventricular Rupture Of Brain Abscess
The MRI FLAIR Image Demonstrates Confluent Subependymal Hyperintensity
And Depen...

The DWI1 And ADC2 Images Are Critical To Differentiate An Abscess From A Cystic Tumor
With An Abscess:
• The DWI (B1000) i...

These findings are redemonstrated on a follow-up CT scan obtained 10-days later, i.e.:
• Diffusion Weighted Image (DWI): h...

New England Journal of Medicine 2014;4(371):447-456.
From: www.EMGuidewire.com

New England Journal of Medicine 2014;4(371):447-456.
From: www.EMGuidewire.com

New England Journal of Medicine 2014;4(371):447-456.
From: www.EMGuidewire.com

IVROBA: Pathophysiology
• Spontaneous intraventricular rupture of brain abscess (IVROBA) is a
potentially fatal complicati...

IVROBA: Imaging Recommendations
• A CT without contrast is still first-line for neuroimaging in the ED
• If a brain absces...

Prodromal Signs and Clinical Factors Influencing Outcome in Patients with
Intraventricular Rupture of Purulent Brain Absce...

Clinical features and predictive factors of intraventricular rupture in patients
who have bacterial brain abscesses.
Journ...

Journal of Neurology Neurosurgery & Psychiatry 2007;78:303-309.
IVROBA1
(n=62)
Non-IVROBA2
(n=117)
Fever/Chills 69% 55%
Al...

Journal of Neurology Neurosurgery & Psychiatry 2007;78:303-309.
Neuroimaging (n=62)
Ependymal Enhancement 90%
Ventricular ...

Surgical Neurology 2006;66:246-251.
The Role Of Diffusion-Weighted Imaging In The Differential Diagnosis Of
Intracranial C...

Surgical Neurology 2006;66:246-251.
A: T2 – hyperintense lesion with surrounding edema
B: DWI – hyperintensity in the cyst...

The Case Continues
The patient was admitted to the ICU and was managed with bilateral external ventricular
drains and IV a...

Ventriculoperitoneal Shunt Placement
CT without contrast demonstrating the course of the ventricular catheter
entering the...

Right Parietal Intraparenchymal Hemorrhage
CT head without contrast demonstrating a large parenchymal hemorrhage
with asso...

Summary
• Spontaneous intraventricular rupture of brain abscess (IVROBA) is a
devastating complication of pyogenic brain a...

Summary
• Early identification and prompt initiation of appropriate treatment is
crucial to provide the best opportunity f...

References
Brain Abscess. New England Journal of Medicine 2014;4(371):447-456.
Prodromal Signs and Clinical Factors Influe...

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