Early entrapment of fourth ventricle following Pseudomonas meningitis in extreme prematurity: Case report

Article type: Case Report

Authors: Edison, P.E.^{a; *} | Sanamandra, S.K.^b | Shah, V.A.^a | Baral, V.R.^a | Yeo, C.L.^a

Affiliations: [a] Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore | [b] Department of Diagnostic Radiology, Singapore General Hospital, Singapore

Correspondence: [*] Address for correspondence: Priyantha Ebenezer Edison, MRCPCH (UK), Department of Neonatal and Developmental Medicine Singapore General Hospital, Singapore. Tel.: +65 63214540; Mobile: +65 9108 4996; Fax: +65 62273670; Postal Address: 20, College Road, Academia, Singapore 169856. E-mail: [email protected].

Abstract: Trapped fourth ventricle (TFV) as a complication of post-hemorrhagic hydrocephalus (PHH) is widely reported in the pediatric population with a prior history of ventriculo-peritoneal (VP) shunt placement. Characterized by disproportionate dilatation of the fourth ventricle on serial neuro-imaging, it is rarely encountered in the early course of preterm infants and the differentiating clinical features are subtle and non-specific. Clinical alertness and sonographic correlation hold the key to early diagnosis. We report an early emergence of TFV in an extremely low gestational age newborn (ELGAN) following fulminant Pseudomonas aeruginosa meningitis, approach to management, and the neurological outcome. Fourth ventricle entrapment as a complication of perinatally acquired Pseudomonas aeruginosa meningitis in a surviving ELGAN is extremely rare.

Keywords: Trapped fourth ventricle, pseudomonas meningitis, mastoid fontanel view, neurophysiological assessment of hydrocephalus, ventricular reservoir

DOI: 10.3233/NPM-190258

Journal: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 581-586, 2020