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.