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Introduction Acute 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. Objective This 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. Methods A search using MEDLINE and EMBASE was carried out including “primary ventriculitis”, “bacterial ventriculitis” or “pyogenic ventriculitis” in the adult population. The cases were summarised. Results A 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. Conclusion Ventriculitis 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.

We present 2 cases of Listeria monocytogenes rhombencephalitis (L-RE), both affecting previously healthy adult men. Each of them developed a diphasic syndrome first characterized by fever, nausea and headache, followed, in a second phase, by severe brain stem dysfunction at the level of the pons, with meningism, multiple cranial nerve palsies, ataxia, and, in one case, seizures. The early examination of the cerebrospinal fluid (CSF) demonstrated the presence of Gram-positive bacilli whose typical characteristics were compatible with those of Listeria, allowing for immediate administration of a specific therapy. Neuroimaging techniques (either CT or MRI) did not provide any evidence of brain stem involvement, and they did not positively contribute to the diagnostic process. The immediate use of a specific antibiotic therapy led to a favourable clinical outcome for both patients.

Publisher Summary This chapter explains the concept of retraction of head. It is usually the result of severe meningitis but can also occur in children as the result of asphyxia. Intermittent spasms of retraction occur in tetanus, strychnine poisoning, rabies, torsion spasm, and spasmodic torticollis. Stiffness of the neck, short of actual retraction, can be due to meningism, meningitis, subarachnoid hemorrhage, meningeal carcinomatosis, and pressure cones resulting from increased intracranial pressure. Meningitis causes resistance to forward flexion of the neck, but this may be absent in very mild cases and also in fulminating infections. Features common to most cases of meningitis are headache, photophobia, vomiting, giddiness, and fever. There may be a rigor, or a convulsion, at the onset of the more virulent types, especially in children. Other forms of pyogenic meningitis are sporadic rather than epidemic in incidence, do not as a rule produce a rash, and are usually derived from a more or less obvious source of infection.

Publisher Summary This chapter describes the clinical aspects of meningitis. In most patients who prove to have meningitis, the need for lumbar puncture is evident on first assessment. Meningeal signs are often found in patients with pneumonia or with acute tonsillitis, in patients generally with high fever, and occasionally in certain specific infections such as typhoid and infectious hepatitis. Meningism of this sort is seen especially in children of school age and in young adults. In this case, the degree of meningism and the weight of evidence favoring a particular etiology other than meningitis determine whether a lumbar puncture should be done. After the neonatal period, three organisms account for the great majority of cases of pyogenic meningitis. These are meningococcus, Haemophilus influenzae, and pneumococcus. They all need to be considered at all ages, but H. influenzae becomes very uncommon after the first few years of life and pneumococcus predominates in older patients. Until recently, other organisms were very rarely found as causes of meningitis except in the neonate, but the increasing incidence of patients with various forms of immunosuppression has led to a greater likelihood that less familiar organisms will be encountered.

This chapter focuses on the bacterial and viral infections and their infestation on the central nervous system. Meningitis must be distinguished from subarachnoid hemorrhage and meningism. The most effective drugs in the chemotherapy of tuberculosis meningitis are isoniazid, streptomycin, ethambutol, rifampicin, pyrazinamide, and ethionamide. In Asian patients, tuberculous meningitis may present as a more chronic disorder and often causes multiple cranial nerve palsies and progressive visual failure caused by arachnoiditis. Brain abscess can be treated with antibiotics and surgical drainage by repeated needle aspiration or primary excision. There is a high incidence of epilepsy after treatment, and a case can be made for prophylactic anticonvulsants. Other systemic bacterial infections that involve the nervous system include tetanus, leptospirosis, diphtheria, enteric fever, botulism, syphilis, and leprosy—Hansen's disease. The effect of virus on the nervous system is closely related to immunity responses, and in some instances, an allergic type of reaction may be the dominant part of the illness. Vaccination is an effective method of inducing active immunity, and in the case of rabies, it can be used after the infection has been acquired. Antiviral drugs act by interfering with the synthesis of DNA or RNA. Three drugs, namely cytarabin, vidarabine, and acyclovir, are widely used in infections of the nervous system. Encephalitis of viral origin must be distinguished from bacterial infection such as tuberculosis, brain abscess, hemiplegic migraine, toxic effects as a result of drugs and poisons such as lead in children, and metabolic disorders such as liver failure and porphyria.

Publisher Summary This chapter discusses the importance of a new approach to analysis of pain in childhood. Pain in adults is a composite of irritation of the receptors, transmission of information, inborn reactions, and the experience of pain. In the small child, this hierarchical structure has not been developed yet. With the exception of torsion of the testis, the most important sources of pain in the first year of life are unimportant in the school child and vice versa. Meningitis, above all in the newborn but more or less in the first year of life, can occur in the absence of meningism, without neck stiffness or Kernig's sign. Pain in the lower-right abdomen, rebound pain, pelvic pain, slight fever, constipation, and leucocytosis of 20,000 are all the more uncertain the younger the child. Umbilical colic is a symptom of childhood because the body, abdomen, and umbilicus are identical for the child. Pains in childhood are particularly liable to be influenced by the environment and the phase of development of the child. Pains associated with malignant disease are independent of the environment. They destroy the differences between pain in childhood and that in grown-ups.