Waheed Amir, Amir Faryal
Department of Acute & General Internal Medicine, Great Western Hospital, Marlborough Road, Swindon SN3 6BB, UK.
Department of General Internal Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK.
Clin Med (Lond). 2025 Jan;25(1):100279. doi: 10.1016/j.clinme.2024.100279. Epub 2024 Dec 18.
We present a case of a 74-year-old woman with headaches, pyrexia and intermittent right-sided otorrhoea and rhinorrhoea. Her nasal discharge tested positive for beta-2-transferrin, confirming a cerebrospinal fluid (CSF) leak. High-resolution CT (HRCT) mastoids showed a defect in the right tegmen, and CSF within the middle ear and mastoid air cells. A gadolinium-enhanced MRI brain showed high signal in the occipital horns of the lateral ventricles with diffusion-weighted imaging (DWI) and a low signal with DWI-apparent diffusion coefficient (DWI-ADC), consistent with ventriculitis. She made an uneventful recovery after 6 weeks of intravenous antibiotics. The patient had surgical repair of bony defects to prevent recurrence. This highlights a rare case of ventriculitis associated with a spontaneous CSF leak, with no existing set diagnostic criteria, and high mortality. High clinical suspicion aided by appropriate imaging, and a multidisciplinary approach to management are imperative.
我们报告一例74岁女性患者，她有头痛、发热以及间歇性右侧耳漏和鼻漏症状。她的鼻腔分泌物β-2转铁蛋白检测呈阳性，证实存在脑脊液（CSF）漏。高分辨率CT（HRCT）乳突扫描显示右侧颅中窝底有缺损，中耳和乳突气房内有脑脊液。钆增强MRI脑部检查显示侧脑室枕角在扩散加权成像（DWI）上呈高信号，在DWI表观扩散系数（DWI-ADC）上呈低信号，符合脑室炎表现。静脉注射抗生素6周后，她顺利康复。患者接受了骨缺损的手术修复以防止复发。这凸显了一例罕见的与自发性脑脊液漏相关的脑室炎病例，目前尚无既定的诊断标准，且死亡率高。借助适当的影像学检查提高临床怀疑度，以及采用多学科管理方法势在必行。
