Case Presentation:
the patient at 2 months of age, with a history of previous NICU and
hospital admissions dating 1 month back, was readmitted due to decreased
oral intake and drowsiness for 2 days. On the examination, the infant
was febrile (101 F), lethargic, with poor muscle bulk bilaterally on all
limbs, and mild dehydration. The patient had a pulse rate of 122 beats
per minute, respiratory rate of 29 breaths per minute, blood oxygen
saturation of 95%, and was normotensive with a Blood pressure of 95/50
mm of Hg. OFC was measured to be 42cm (below 3rdcentile) and disproportionately large with bulging anterior fontanelle.
Setting-sun sign (upward-gaze paresis) was positive indicating
neurological complications.
Serial radiological investigations before admission were as followed;
first USG Brain at birth showed dilated entire ventricular chain,
indicating communicating hydrocephalus. Repeat USG brain at 2 months of
age showed obstructive hydrocephalus with trans-ependymal seepage and
Foci of calcification
MRI Brain done on readmission showed that the patient developed
communicating obstructive hydrocephalus and Ventriculitis secondary to
meningitis, which was non-resolving despite prolonged antibiotic
therapy. An external ventricular drain (EVD) was placed for
cerebrospinal fluid (CSF) drainage and continued antibiotic therapy.