SUSPECTED RHOMBENCEPHALITIS WITH VENTRICULITIS IN AN ELDERLY PATIENT WITH PREVIOUS MENINGITIS AND VENTRICULOPERITONEAL SHUNT: A CASE REPORT

Abstract

Rhombencephalitis is a rare inflammatory disorder involving the brainstem and cerebellum, with a broad differential diagnosis that includes infectious, autoimmune, paraneoplastic, and post-infectious causes. Diagnostic evaluation may be particularly challenging in elderly patients with previous central nervous system pathology and cerebrospinal fluid diversion devices.

We report the case of a 75-year-old man admitted with progressive neurological deterioration manifested by vertigo, gait instability, somnolence, confusion, and dysphagia. Brain magnetic resonance imaging revealed inflammatory changes involving the medulla oblongata and cerebellar peduncle, accompanied by ependymal and ventricular wall enhancement consistent with rhombencephalitis and ventriculitis. Cerebrospinal fluid analysis demonstrated elevated protein levels and blood–cerebrospinal fluid barrier dysfunction with minimal pleocytosis. Extensive microbiological, molecular, and immunological investigations, including polymerase chain reaction testing for neurotropic viruses and Mycobacterium tuberculosis, were negative. The patient had a history of meningitis six years earlier, complicated by hydrocephalus requiring ventriculoperitoneal shunt placement.

The patient was treated with anti-edematous, empirical antimicrobial, and supportive therapy, resulting in partial clinical improvement. This case highlights the diagnostic complexity of rhombencephalitis in elderly patients with prior central nervous system disease and emphasizes the importance of a multidisciplinary approach and careful exclusion of infectious etiologies.