Obstruction of the outlets of the fourth ventricle and high spinal subarachnoid block developed in a patient with Coccidioides immitis meningitis. Radioisotope visualization procedures demonstrated absence of communication between basal meningeal areas, cerebral ventricles, and spinal theca. Drugs instilled in the crebrospinal fluid could not be effectively delivered to the basal meninges because of the two blocks. Isotope ventriculography and cisternography may be particularly useful in evaluating routes of drug administration in chronic fungal meningitis.
McCullough DC, Harbert JC. Isotope Demonstration of CSF PathwaysGuide to Antifungal Therapy in Coccidioidal Meningitis. JAMA. 1969;209(4):558-560. doi:10.1001/jama.1969.03160170054018