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Pyogenic ventriculitis (pyoventriculitis) is characterized by the existence of suppurative fluid in the cerebral ventricular system. It may result from the rupture of a brain abscess, extension of meningitis into the ventricles, implantation of pathogens following a head injury, or a neurosurgical procedure with or without an implanted device. The typically indolent clinical course of pyoventriculitis sometimes can be rapidly life-threatening. Signs and symptoms are those of meningitis and raised intracranial pressure. Focal neurologic deficits may be present when a brain abscess is associated. Neuroimaging techniques are fundamental in the diagnosis. CT scan and especially MRI usually demonstrate intraventricular debris and pus in the cerebrospinal fluid (CSF). Other findings may include hydrocephalus, periventricular anomalies, and ventricular ependymal enhancement. CSF studies usually show a low glucose level, high protein, and pleocytosis. Isolation of the pathogenic agent and culture are essential in determining the antimicrobial therapy. When ventriculitis is unresponsive to intravenous antibiotics or if neurologic status is considered perilous, intrathecal antibiotic drugs can be administered. Concomitant brain abscess may be drained. Pyogenic ventriculitis is a potentially fatal infection that can lead to severe sequelae.