1340. Successful Management of Intraventricular Rupture of Pyogenic Brain Abscess: Case Report and Systematic Review of Literature

Authors: Abdelsimar Tan Omar; Kathleen Joy Khu (Manila, Philippines)

Introduction: Intraventricular rupture of brain abscess (IVROBA) is one of the most dreaded complications of pyogenic brain abscesses due to its high mortality rate. Because of its relative infrequency and generally poor outcome, the optimal management of this condition remains to be determined. Methods: We report the case of a 5-year old female presenting with headache and fever followed by seizure and decrease in sensorium. Neuroimaging showed multiple right temporal abscesses, communicating hydrocephalus, and fluid-fluid levels within the ventricles. The patient underwent insertion of an external ventricular drain (EVD), then later a ventriculoperitoneal shunt after the hydrocephalus persisted. After completing intravenous antibiotic treatment, she was discharged well with no focal neurologic deficits. We performed a systematic review of the SCOPUS and PubMed databases for case reports and case series documenting patients who survived after treatment for IVROBA. Results: A total of 24 cases of IVROBA survivors were reported in the literature, including the present case. The median age was 48.5 years (range: 5-71), with males comprising 75% of cases. The most common location of the brain abscesses was temporal while the most common route of spread was hematogenous. Surgery was performed in 92% of cases, with EVD insertion being the most common surgical procedure, followed by burr hole and aspiration of the abscess. Twenty nine percent of cases required a VP shunt. Medical management consisted of a combination of intraventricular and systemic antibiotics in 43% of cases and systemic antibiotics alone in 35%. The duration of systemic antibiotic treatment ranged from 4 to 11 weeks while intraventricular antibiotics were given for 2 to 4 weeks. Conclusion: The management of IVROBA in this series varied widely, with surgery playing an important role. Although IVROBA is considered a devastating complication of intracranial abscess, a good outcome may be achieved with timely intervention.