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Ventriculitis

Ventriculitis may occur through the involvement of the ependymal lining of the ventricles in 30% of patients. This complication is especially common in neonates, with an incidence as high as 92%. The organisms enter the ventricles via the choroid plexuses. As a result of reduced CSF flow, and possibly reduced secretion of CSF by the choroid plexus, the infective organisms remain in the ventricles and multiply.

Ventriculomegaly

Ventriculomegaly can occur early or late in the course of meningitis and is usually transient and mild to moderate in severity. As a result of the subarachnoid inflammatory exudate, CSF pathways may become obstructed, leading to hydrocephalus. Exudates in the foramina of Luschka and Magendie can cause noncommunicating hydrocephalus, whereas exudates that accumulate in the basilar cisterns or over the cerebral convexity can develop into communicating hydrocephalus.

Diagnostic Considerations

Diagnoses to consider aside from meningitis include the following:

• Noninfectious meningitis, including medication-induced meningeal inflammation
• Meningeal carcinomatosis
• CNS vasculitis
• Stroke
• Encephalitis
• All causes of altered mental status and coma
• Leptospirosis
• Subdural empyema

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