<%server.execute "isdev.asp"%> Ventriculitis and hydrocephalus with hypoglycorrhachia in congenital toxoplasma infection Kapoor A, Sodhi HB, Dhandapani S - J Pediatr Neurosci
home : about us : ahead of print : current issue : archives search instructions : subscriptionLogin 
Users online: 1147      Small font sizeDefault font sizeIncrease font size Print this page Email this page

  Table of Contents    
Year : 2016  |  Volume : 11  |  Issue : 1  |  Page : 91-92

Ventriculitis and hydrocephalus with hypoglycorrhachia in congenital toxoplasma infection

Department of Neurosurgery, PGIMER, Chandigarh, India

Date of Web Publication27-Apr-2016

Correspondence Address:
Ankur Kapoor
Department of Neurosurgery, Flat No. E-33 GHS 94, Sector 20, Panchkula - 138 009, Haryana
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1817-1745.181270

Rights and Permissions


How to cite this article:
Kapoor A, Sodhi HB, Dhandapani S. Ventriculitis and hydrocephalus with hypoglycorrhachia in congenital toxoplasma infection. J Pediatr Neurosci 2016;11:91-2

How to cite this URL:
Kapoor A, Sodhi HB, Dhandapani S. Ventriculitis and hydrocephalus with hypoglycorrhachia in congenital toxoplasma infection. J Pediatr Neurosci [serial online] 2016 [cited 2022 May 23];11:91-2. Available from: https://www.pediatricneurosciences.com/text.asp?2016/11/1/91/181270


Congenital central nervous system toxoplasmosis can present in varied different forms. One of its rarest presentations is isolated hydrocephalus and ventriculitis with no parenchymal lesion.

A 4-month-old child was brought to the hospital with a complaint of enlarging head size, fever, and poor feeding for 3 weeks. Examination revealed enlarged head circumference and bulging anterior fontanelle. Ultrasonography showed increased echogenicity of ventricles while gadolinium-magnetic resonance (MR) revealed hydrocephalus with no focal parenchymal lesions. The debris within the ventricle was evident on MR imaging as focal hypointense lesion within the ventricle on T2-weighted image [Figure 1]. Cerebrospinal fluid (CSF) analysis showed sugar 12 mg/dl, counts 450/mm 3, and proteins 60 mg/dl. CSF was positive for polymerase chain reaction for toxoplasma while immunoglobulin G (IgG) and IgM were both negative. With a working diagnosis of congenital toxoplasmosis, the child was started on sulfadiazine and pyrimethamine therapy. The child improved clinically, started tolerating feeds and cells in CSF decreased, but sugars persistently remained below 20 mg/dl. Since the CSF picture was normal other than sugar value, we proceeded ahead with endoscopic third ventriculostomy for persistent hydrocephalus, 3 weeks later.
Figure 1: (a) T2-weighted image showing hydrocephalus with hypointensity of mural nodule in right lateral ventricle. (b) T1-weighted contrast image showing contrast enhancement of mural nodule

Click here to view

Congenital toxoplasmosis results from the transplacental passage of the toxoplasma gondi parasite from the mother to the fetus. Though the majority of babies are asymptomatic, some may present with anemia, jaundice, hepatosplenomegaly, seizures, hydrocephalus, chorioretinitis, and sensori-neural deafness. Radiology shows ring enhancing lesions at corticomedullary junction, white matter of basal ganglia (75–88%), thalamus or as diffuse cerebritis.[1],[2] Ventriculitis and consecutive obstructive hydrocephalus may occur due to compression of CSF outflow pathway by ring enhancing lesions or ventriculitis.[1],[3] Postcontrast periventricular enhancement on MR imaging is consistent with ventriculitis.[2],[4] Though antitoxoplasma therapy alone may suffice and spontaneous resolution of hydrocephalus may be seen, the enlarging head circumference in our patient made CSF diversion compulsory.[4] We emphasize on early suspicion of toxoplasmosis in newborns with hydrocephalus and to proceed with CSF diversion for hydrocephalus despite persistent hypoglycorrhachia.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Akgoz A, Mukundan S, Lee TC. Imaging of rickettsial, spirochetal, and parasitic infections. Neuroimaging Clin N Am 2012;22:633-57.  Back to cited text no. 1
Mohamed S, Osman A, Al Jurayyan NA, Al Nemri A, Salih MA. Congenital toxoplasmosis presenting as central diabetes insipidus in an infant: A case report. BMC Res Notes 2014;7:184.  Back to cited text no. 2
Cota GF, Assad EC, Christo PP, Giannetti AV, Santos Filho JA, Xavier MA. Ventriculitis: A rare case of primary cerebral toxoplasmosis in AIDS patient and literature review. Braz J Infect Dis 2008;12:101-4.  Back to cited text no. 3
Basavaprabhu A, Soundarya M, Deepak M, Satish R. CNS toxoplasmosis presenting with obstructive hydrocephalus in patients of retroviral disease – A case series. Med J Malaysia 2012;67:214-6.  Back to cited text no. 4


  [Figure 1]


Print this article  Email this article
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (575 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

    Article Figures

 Article Access Statistics
    PDF Downloaded88    
    Comments [Add]    

Recommend this journal