Female, 4 months old, with Escherichia coli meningitis/cerebritis/ventriculitis with EVD in place. Evaluate for abscesses and ventricular size. A right frontal approach EVD is in place with its distal tip passing through the right foramen of Monro and terminating within the third ventricle. The lateral, third and fourth ventricles remain markedly dilated without significant change from the prior examination.Diffusion restricting debris continues to layer within the occipital horns, slightly reduced in quantity from the prior examination. Diffusion restricting debris and/or loculated fluid previously seen within the fourth ventricle and foramina of Luschka have almost completely resolved.A rim-enhancing, diffusion restricting extra-axial collection along the left parietal lobe is redemonstrated. This collection was previously lenticular in morphology and has become more oval in shape now measuring 29 x 18 mm, previously 35 x 12 mm. This collection exerts mild local mass effect on the adjacent brain parenchyma.Diffuse leptomeningeal enhancement has improved relative to the prior examination. Of note, the ependymal enhancement, which was previously diffuse, is now only seen in the periatrial and occipital regions. No new rim-enhancing collections are demonstrated.Trace susceptibility effect along the caudothalamic grooves is unchanged. A focus of susceptibility in the right cerebellar hemisphere is also unchanged. Periventricular T2 hyperintensity has improved, particularly in the right parietal and occipital lobes. There may be some new T2 signal abnormality within the right pons but this could also be artifactual. The choroid plexi appear to be adhering to the medial ventricular walls.
Findings are again seen compatible with extensive intracranial infection. The shunted ventricular system remains markedly enlarged similar to that seen previously. Leptomeningeal and ependymal enhancement have improved which may reflect a response to therapy. The quantity of layering infectious debris within the ventricular system has also diminished slightly.An extra-axial collection compatible with an abscess along the left parietal lobe has changed in shape, becoming more oval and less lenticular. The overall volume of the abscess is stable or at most minimally increased.Scattered areas of parenchymal edema have improved. No new intracranial collections are detected.