Adult Primary Ventriculitis as a complication of acute otitis media: A comprehensive review of reported cases

Abstract

IntroductionAcute primary bacterial ventriculitis in adults is a rare intracranial disease. It can be a complication of neurosurgical patients with ventricular stent insertions or in children. ObjectiveThis paper presents a case of acute otitis media in a 71-year-old diabetic male that progressed rapidly to acute ventriculitis, with a literature review of presentation, work up, management and patient outcomes. MethodsA search using MEDLINE and EMBASE was carried out including “primary ventriculitis”, “bacterial ventriculitis” or “pyogenic ventriculitis” in the adult population. The cases were summarised. ResultsA total of 13 case reports were analysed. There was only one other case of pyogenic ventriculitis presenting with of sudden onset hearing loss, which turned out to be a complication of ventriculitis. Common presenting symptoms included agitation, depressed consciousness but no case reported any signs of meningism. This is the only known case of ventriculitis following acute otitis media. ConclusionVentriculitis can result as a complication of otological disease; it can manifest as rapid neurological deterioration and is difficult to diagnose. A high index of suspicion should be held for ventriculitis in cases with rapid progression or severity. Optimal work up includes serial MRI and lumbar puncture, for prolonged, targeted antimicrobial therapy.