成人高毒性克雷白氏肺炎菌性腦膜炎後發生早期出現的孤立性第四腦室水腦症：一個病例報告

Early Emergence of Isolated Fourth Ventricle Following Hypervirulent Klebsiella Pneumoniae Meningitis in an Adult Patient: A Case Report Review

孤立性第四腦室水腦症是一種少見的現象，通常發生在兒童。一般在顱內出血或腦膜炎後因為水腦症而放置腦室-腹腔分流管後數年發生。我們報告一個54歲女性因為高毒性克雷白氏肺炎菌感染造成:肝膿瘍，尿道感染，肺炎，腦膜炎及腦膿瘍。雖然在適當的抗生素治療及膿瘍引流後感染症得到良好控制，但病人卻在三週內發生孤立性第四腦室水腦症。經多重腦室-腹腔分流管置放手術；包括第四腦室-腹腔分流管置放，病人得以存活。經由這樣一個病例，提醒我們對中樞神經感染後的孤立性第四腦室水腦症要有臨床的警覺性。必要時較頻繁的電腦斷層檢查可提供臨床診斷的正確性。

An isolated fourth ventricle (IFV) is a rare condition mainly documented in pediatric cases. It typically arises when ventricular shunts are placed to manage hydrocephalus following hemorrhage or meningitis. We report the case of a 54-year-old woman with a hypervirulent Klebsiella pneumoniae (hvKP) infection that led to various complications, including liver abscesses, urinary tract infections, pneumonia, meningitis, and brain abscess. Central nervous system (CNS) infection management encompassed antibiotics for meningitis, external ventriclar drainage for post-meningitis hydrocephalus, and suboccipital craniectomy for the removal of cerebellar abscesses. The patient developed an early IFV and compartmentalized hydrocephalus within 3 weeks. Following adequate control of the CNS infection, we administered multiple shunt catheters, including a fourth ventriculoperitoneal shunt. This case report highlights the possibility of early IFV emergence in adults following a CNS infection with hvKP. Early detection of IFV post-CNS infection necessitates high clinical vigilance. Regular brain computed tomography scans can provide valuable information regarding the posterior fossa and ventricular system in high-risk patients. In most IFV cases, the placement of a fourth ventricle drain is required for treatment.