67 year old male with a history of lung cancer presented with headache, fever and decreased level of consciousness. MRI brain revealed several brain abscesses with the largest in the periventricular space (upper image above). The patient was started on intravenous antibiotics. Later, the patient became even less responsive. Urgent CT scan of his brain showed rupture of the brain abscess into the ventricle and developing hydrocephalus (see image above with arrow pointing to the hyperdense material in the ventricle). Ventricular drain was placed and the patient was started on intrathecal antibiotics.