Spontaneous intraventricular rupture of pyogenic brain abscess: A short series of three cases and review of literature

BACKGROUND: Spontaneous intraventricular rupture of brain abscess (IVROBA) is a dreaded complication of pyogenic brain abscess (PBA) and is associated with very high mortality. We discuss the clinical, radiological, and therapeutic aspects associated with this potentially fatal complication of PBAs. CASE DESCRIPTIONS: Three cases of spontaneous IVROBA presenting to our institute over a period of 6 months were reviewed with respect to their clinical and radiological presentation, their therapeutic plan, and neurological outcome. Individualized approach to our patients with IVROBA with abscess drainage/excision, intrathecal and intravenous antibiotic therapy, cerebrospinal fluid (CSF) diversion (if under high pressure), and close monitoring of clinical status, CSF reports, and computed tomography (CT) scan findings enabled us to achieve good neurological outcome in two patients presenting in conscious state; however, one patient presenting in poor neurological status succumbed to IVROBA due to fulminant septic arteritis. CONCLUSION: In the present neurosurgical era, IVROBA is rarely encountered; however when it occurs, patient outcome is adversely affected. Early detection and prompt aggressive management, as seen in our short series, can give the patient a fighting chance and significantly improve the neurological outcome.