Ventriculitis
Encyclopedia
Ventriculitis is the inflammation
of the ventricles in the brain. The ventricles are responsible for containing and circulating cerebrospinal fluid
throughout the brain. Ventriculitits is caused by and infection
in the ventricles, leading to an immune response in the cells lining them, followed by swelling and inflammation. This is especially prevalent in patients with external ventricular drains and intraventricular stints. Ventriculitis can cause a wide variety of short-term symptoms and long-term side effects ranging from headaches and dizziness to unconsciousness and death if not treated early.
Ventriculitis is usually diagnosed using an MRI or CT scan of the brain, showing inflammation and testing of the cerebrospinal fluid for bacteria and viruses that might be causing the desease. Ventriculitis is treated with some appropriate combination of antibiotics in order to rid the patient of the underlying infection. Prevention of ventriculitis is difficult, but best enabled by maintaining a sterile environment whenever an operation involves exposing the patient’s brain and ventricles in particular.
There is a great deal of research taking place involving ventriculitis and similar diseases. It focuses specifically around defining ventriculitis and what causes it. This will allow for much more advancement in the subject, especially into demographic data, such as common causes, who are the most at risk, and what factors affect the course and symptoms of each individual, case of the disease. There is also a lot of attention being paid to possible treatments and prevention methods to help make this disease even less prevalent and dangerous.
serves to keep pathogen
s from entering the sensitive areas of the brain. However, when those natural defenses are by-passed in the hospital setting, the brain is suddenly exposed to a host of potentially harmful bacteria and viruses.
Patients that have had invasive brain surgery or procedures are considered to be the most at risk for experiencing ventriculitis. Two procedures, in particular have been studied extensively due to their high rate of ventriculitis contractions post operation. The first group consists of patients that have had an external ventricular drain implanted to allow physicians to reduce the intracranial pressure
they experience. The duration that the drain is implanted varies by necessity, however, the longer the drain is in, the more likely an infection will occur. The second group consists of patients that have an implanted intracranial stint. Both groups of patients have a much higher rate of ventriculitis than the general populace, though there is very little supporting evidence due to the lack of definition of ventriculitis as frequent misdiagnosis. Nearly 25% of patients with an external ventricular drain experience infection-based meningitis or ventriculitis.
Patients often present with headaches, painful cranial pressure, and neck pain early in the progression of the disease. Patients with a more advanced infection have been known to complain of many different neurological effects such as dizziness, confusion, and slurred speech. Very advanced cases can lead to mental instability, nausea, vomiting, rigors, and temporary loss of consciousness. Many patients with ventriculitis also experience some degree of hydrocephalus, which is the build up of cerebrospinal fluid due to the inability of the ventricles to reabsorb and correctly circulate the fluid. If left untreated, ventriculitis can lead to serious inhibition of mental function and even death.
The symptoms vary greatly, in part, because of the underlying or causing infection. While the inflammation that is ventriculitis can cause a number of effects such as those mentioned previously, the base infection could cause other symptoms that don’t necessarily have to do with the ventriculitis, itself. One of the challenges doctors face in diagnosing ventriculitis is distinguishing indicative symptoms in spite of the wide variety of possible presentations of the disease. A great deal of emphasis is being put on research into better and faster ways to diagnose ventriculitis without the delay inherent with microbiological testing of the cerebrospinal fluid.
The progression of the disease is also largely dependent on the nature of the specific case. Depending on the underlying infection, the way it entered the brain, and the type and timing of treatment, the infection may spread or recess on the order of months or days. Ventriculitis is a very serious condition and should be treated early to ensure as little lasting damage as possible.
(CT) or magnetic resonance imaging
(MRI) technology to “take a picture” of the brain. The scans allows physicians to check for “intraventricular debris and pus, abnormal periventricular and subependymal signal intensity, and enhancement of the ventricular lining,” all of which indicate the likelihood of ventriculitis. MRIs have been reported as being highly effective and sensitive in detecting such indicators, even from an early stage.
After determining whether or not a patient has ventriculitis, the doctor may choose to pursue a more specific and useful diagnosis to find the cause of the ventriculitis. This is done by obtaining a sample of cerebrospinal fluid, most commonly via a procedure called a lumbar puncture
or spinal tap
. For patients with an implanted external ventricular drain, cerebrospinal fluid can be collected from the drain’s output. After the sample of fluid is obtained, a battery of tests will be performed to identify any offending pathogen or infection agent. The test will also determine any resistance the pathogen may have to antibiotics. By identifying the viral or bacterial cause of the ventriculitis, doctors are more able to effectively treat the inflammation and infection. This procedure is fairly effective, but is rarely able to isolate anaerobic
organisms that may be causing the inflammation, giving cause for further research and procedural development.
It is important to note that, though they present with similar symptoms and often occur in tandem, meningitis
and ventriculitis are two different diseases, so physicians must be able to distinguish between the two. Meningitis is the inflammation of the protective lining of the central nervous system, called meninges
. Because of the similar pathologies and etiologies of the two types of inflammation, they are difficult to differentiate using chemical testing, but show very different visual effects in both the MRI and CT scans, hence their use as a validation that the patient does, in fact, have ventriculitis and not another, but deceptively similar condition such as meningitis.
regimen targeting the underlying infection causing the inflammation. Typically, the physician will order the patient be placed on broad-spectrum antibiotic
s in order to manage the symptoms and control the infection while the cerebrospinal fluid samples are analyzed. When a specific bacterial or viral cause is found, the doctor will change the treatment accordingly. There is some debate as to the most effective antibiotics and the best ways to introduce the drugs (e.g. intravenously, orally, etc.), however it is agreed that drug effectiveness is limited by the difficulty of non-invasively allowing the drugs to enter the cerebrospinal fluid.
Should intracranial pressure reach unsafe levels, the patient may need to have cerebrospinal fluid drained. Implanted external ventricular drains are one of the more common ways to manage and monitor the intracranial pressure, however there are several risks involved with such an invasive procedure, including the risk of further infection.
There is a great deal of research focused around prevention of ventriculitis. It is crucial that any procedure involving exposing the brain is performed with the utmost care, as infections in the brain are very dangerous and potentially deadly. When patients undergo such procedures, they are often monitored closely over the next several days to ensure that there were no infections and any instance of even a small headache is treated very seriously. It is also necessary to monitor the intracranial pressure
of the patients often enough to observe significant changes that could indicate the presence of and infection and ensuing ventriculitis. It is important not to measure the pressure too often, however, as it could in fact lead to infection.
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
of the ventricles in the brain. The ventricles are responsible for containing and circulating cerebrospinal fluid
Cerebrospinal fluid
Cerebrospinal fluid , Liquor cerebrospinalis, is a clear, colorless, bodily fluid, that occupies the subarachnoid space and the ventricular system around and inside the brain and spinal cord...
throughout the brain. Ventriculitits is caused by and infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
in the ventricles, leading to an immune response in the cells lining them, followed by swelling and inflammation. This is especially prevalent in patients with external ventricular drains and intraventricular stints. Ventriculitis can cause a wide variety of short-term symptoms and long-term side effects ranging from headaches and dizziness to unconsciousness and death if not treated early.
Ventriculitis is usually diagnosed using an MRI or CT scan of the brain, showing inflammation and testing of the cerebrospinal fluid for bacteria and viruses that might be causing the desease. Ventriculitis is treated with some appropriate combination of antibiotics in order to rid the patient of the underlying infection. Prevention of ventriculitis is difficult, but best enabled by maintaining a sterile environment whenever an operation involves exposing the patient’s brain and ventricles in particular.
There is a great deal of research taking place involving ventriculitis and similar diseases. It focuses specifically around defining ventriculitis and what causes it. This will allow for much more advancement in the subject, especially into demographic data, such as common causes, who are the most at risk, and what factors affect the course and symptoms of each individual, case of the disease. There is also a lot of attention being paid to possible treatments and prevention methods to help make this disease even less prevalent and dangerous.
Cause and Biological Basis
Ventriculitis is caused by an infection of the ventricles, causing an immune response in the lining, which in turn, leads to inflammation. The ventriculitis, is in truth, a complication of the initial infection or abnormality. The underlying infection can come in the form of a number of different bacteria or viruses. The data seems to point to Staphylococci as the leading bacterial cause of infection leading to ventriculitis being present in about 90% of cases, but generally, what is of more concern is the way the infection entered the ventricles. The brain in its natural state is very protected from infection. The blood-brain barrierBlood-brain barrier
The blood–brain barrier is a separation of circulating blood and the brain extracellular fluid in the central nervous system . It occurs along all capillaries and consists of tight junctions around the capillaries that do not exist in normal circulation. Endothelial cells restrict the diffusion...
serves to keep pathogen
Pathogen
A pathogen gignomai "I give birth to") or infectious agent — colloquially, a germ — is a microbe or microorganism such as a virus, bacterium, prion, or fungus that causes disease in its animal or plant host...
s from entering the sensitive areas of the brain. However, when those natural defenses are by-passed in the hospital setting, the brain is suddenly exposed to a host of potentially harmful bacteria and viruses.
Patients that have had invasive brain surgery or procedures are considered to be the most at risk for experiencing ventriculitis. Two procedures, in particular have been studied extensively due to their high rate of ventriculitis contractions post operation. The first group consists of patients that have had an external ventricular drain implanted to allow physicians to reduce the intracranial pressure
Intracranial pressure
Intracranial pressure is the pressure inside the skull and thus in the brain tissue and cerebrospinal fluid . The body has various mechanisms by which it keeps the ICP stable, with CSF pressures varying by about 1 mmHg in normal adults through shifts in production and absorption of CSF...
they experience. The duration that the drain is implanted varies by necessity, however, the longer the drain is in, the more likely an infection will occur. The second group consists of patients that have an implanted intracranial stint. Both groups of patients have a much higher rate of ventriculitis than the general populace, though there is very little supporting evidence due to the lack of definition of ventriculitis as frequent misdiagnosis. Nearly 25% of patients with an external ventricular drain experience infection-based meningitis or ventriculitis.
Symptoms
There is great deal of variety in the symptoms associated with ventriculitis. The symptoms vary based on a number of different factors including severity of inflammation, underlying cause, and the individual patient.Patients often present with headaches, painful cranial pressure, and neck pain early in the progression of the disease. Patients with a more advanced infection have been known to complain of many different neurological effects such as dizziness, confusion, and slurred speech. Very advanced cases can lead to mental instability, nausea, vomiting, rigors, and temporary loss of consciousness. Many patients with ventriculitis also experience some degree of hydrocephalus, which is the build up of cerebrospinal fluid due to the inability of the ventricles to reabsorb and correctly circulate the fluid. If left untreated, ventriculitis can lead to serious inhibition of mental function and even death.
The symptoms vary greatly, in part, because of the underlying or causing infection. While the inflammation that is ventriculitis can cause a number of effects such as those mentioned previously, the base infection could cause other symptoms that don’t necessarily have to do with the ventriculitis, itself. One of the challenges doctors face in diagnosing ventriculitis is distinguishing indicative symptoms in spite of the wide variety of possible presentations of the disease. A great deal of emphasis is being put on research into better and faster ways to diagnose ventriculitis without the delay inherent with microbiological testing of the cerebrospinal fluid.
The progression of the disease is also largely dependent on the nature of the specific case. Depending on the underlying infection, the way it entered the brain, and the type and timing of treatment, the infection may spread or recess on the order of months or days. Ventriculitis is a very serious condition and should be treated early to ensure as little lasting damage as possible.
Diagnosis
Ventriculitis is commonly diagnosed using a variety of tests or procedures. When a physician suspects that a patient has ventriculitis, the first step is typically to ascertain the presence of the inflammation using computed tomographyComputed tomography
X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
(CT) or magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
(MRI) technology to “take a picture” of the brain. The scans allows physicians to check for “intraventricular debris and pus, abnormal periventricular and subependymal signal intensity, and enhancement of the ventricular lining,” all of which indicate the likelihood of ventriculitis. MRIs have been reported as being highly effective and sensitive in detecting such indicators, even from an early stage.
After determining whether or not a patient has ventriculitis, the doctor may choose to pursue a more specific and useful diagnosis to find the cause of the ventriculitis. This is done by obtaining a sample of cerebrospinal fluid, most commonly via a procedure called a lumbar puncture
Lumbar puncture
A lumbar puncture is a diagnostic and at times therapeutic procedure that is performed in order to collect a sample of cerebrospinal fluid for biochemical, microbiological, and cytological analysis, or very rarely as a treatment to relieve increased intracranial pressure.-Indications:The...
or spinal tap
Spinal tap
Spinal Tap can refer to:*Lumbar puncture, a medical procedure colloquially referred to as a "spinal tap"*Spinal Tap , a parody fictional heavy metal band*This Is Spinal Tap, a mockumentary about the same band...
. For patients with an implanted external ventricular drain, cerebrospinal fluid can be collected from the drain’s output. After the sample of fluid is obtained, a battery of tests will be performed to identify any offending pathogen or infection agent. The test will also determine any resistance the pathogen may have to antibiotics. By identifying the viral or bacterial cause of the ventriculitis, doctors are more able to effectively treat the inflammation and infection. This procedure is fairly effective, but is rarely able to isolate anaerobic
Anaerobic
Anaerobic is a word which literally means without oxygen, as opposed to aerobic.In wastewater treatment the absence of oxygen is indicated as anoxic; and anaerobic is used to indicate the absence of a common electron acceptor such as nitrate, sulfate or oxygen.Anaerobic may refer to:*Anaerobic...
organisms that may be causing the inflammation, giving cause for further research and procedural development.
It is important to note that, though they present with similar symptoms and often occur in tandem, meningitis
Meningitis
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...
and ventriculitis are two different diseases, so physicians must be able to distinguish between the two. Meningitis is the inflammation of the protective lining of the central nervous system, called meninges
Meninges
The meninges is the system of membranes which envelopes the central nervous system. The meninges consist of three layers: the dura mater, the arachnoid mater, and the pia mater. The primary function of the meninges and of the cerebrospinal fluid is to protect the central nervous system.-Dura...
. Because of the similar pathologies and etiologies of the two types of inflammation, they are difficult to differentiate using chemical testing, but show very different visual effects in both the MRI and CT scans, hence their use as a validation that the patient does, in fact, have ventriculitis and not another, but deceptively similar condition such as meningitis.
Treatment
Treatment of ventriculitis is critical. If left untreated, it could lead to severe brain damage and even death in some cases. Currently, the only commonly employed treatments of ventriculitis involve an antibioticAntibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
regimen targeting the underlying infection causing the inflammation. Typically, the physician will order the patient be placed on broad-spectrum antibiotic
Broad-spectrum antibiotic
The term broad-spectrum antibiotic refers to an antibiotic that acts against a wide range of disease-causing bacteria. A broad-spectrum antibiotic acts against both Gram-positive and Gram-negative bacteria, in contrast to a narrow-spectrum antibiotic, which is effective against specific families of...
s in order to manage the symptoms and control the infection while the cerebrospinal fluid samples are analyzed. When a specific bacterial or viral cause is found, the doctor will change the treatment accordingly. There is some debate as to the most effective antibiotics and the best ways to introduce the drugs (e.g. intravenously, orally, etc.), however it is agreed that drug effectiveness is limited by the difficulty of non-invasively allowing the drugs to enter the cerebrospinal fluid.
Should intracranial pressure reach unsafe levels, the patient may need to have cerebrospinal fluid drained. Implanted external ventricular drains are one of the more common ways to manage and monitor the intracranial pressure, however there are several risks involved with such an invasive procedure, including the risk of further infection.
There is a great deal of research focused around prevention of ventriculitis. It is crucial that any procedure involving exposing the brain is performed with the utmost care, as infections in the brain are very dangerous and potentially deadly. When patients undergo such procedures, they are often monitored closely over the next several days to ensure that there were no infections and any instance of even a small headache is treated very seriously. It is also necessary to monitor the intracranial pressure
Intracranial pressure
Intracranial pressure is the pressure inside the skull and thus in the brain tissue and cerebrospinal fluid . The body has various mechanisms by which it keeps the ICP stable, with CSF pressures varying by about 1 mmHg in normal adults through shifts in production and absorption of CSF...
of the patients often enough to observe significant changes that could indicate the presence of and infection and ensuing ventriculitis. It is important not to measure the pressure too often, however, as it could in fact lead to infection.