• Amir Waheed and Faryal Amir.
• Department of Acute & General Internal Medicine, Great Western Hospital, Marlborough Road, Swindon SN3 6BB, UK. Electronic address: amir.waheed1@nhs.net.
• Clin Med (Lond). 2024 Dec 18; 25 (1): 100279100279.

AbstractWe present a case of a 74-year-old woman with headaches, pyrexia and intermittent right-sided otorrhoea and rhinorrhoea. Her nasal discharge tested positive for beta-2-transferrin, confirming a cerebrospinal fluid (CSF) leak. High-resolution CT (HRCT) mastoids showed a defect in the right tegmen, and CSF within the middle ear and mastoid air cells. A gadolinium-enhanced MRI brain showed high signal in the occipital horns of the lateral ventricles with diffusion-weighted imaging (DWI) and a low signal with DWI-apparent diffusion coefficient (DWI-ADC), consistent with ventriculitis. She made an uneventful recovery after 6 weeks of intravenous antibiotics. The patient had surgical repair of bony defects to prevent recurrence. This highlights a rare case of ventriculitis associated with a spontaneous CSF leak, with no existing set diagnostic criteria, and high mortality. High clinical suspicion aided by appropriate imaging, and a multidisciplinary approach to management are imperative.Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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