Consumption of caffeine-containing beverages improves sustained attention and alertness but has no effect on strength or static muscular endurance.

Brain abscess remains a serious neurosurgical emergency despite advances in diagnostic imaging, antimicrobial therapy, and minimally invasive surgical techniques. While overall prognosis has improved, intraventricular rupture of brain abscess (IVROBA) dramatically worsens outcomes, converting a localized infection into diffuse ventriculitis and meningoencephalitis, often precipitating rapid neurological deterioration and systemic sepsis. Reported mortality rates remain exceptionally high, ranging from 84% to 100%, even with aggressive management.[,,] The pathophysiology of IVROBA is multifactorial. Rupture typically occurs when the abscess capsule, thinner and poorly vascularized on the ventricular side, succumbs to intracavitary pressure or inflammatory necrosis, allowing purulent material to breach the ventricular cavity.[,,] This leads to widespread bacterial dissemination, hydrocephalus, and diffuse cerebral edema. Clinically, patients may deteriorate precipitously, progressing from a relatively stable neurological state to coma within hours. Early signs of impending rupture may include sudden worsening headache, altered mental status, new-onset meningismus, or acute ventricular enlargement on imaging. However, these warning signs are often subtle or absent, making early identification particularly challenging in routine practice. Neuroimaging plays a critical role in diagnosis. Hallmark radiological findings include intraventricular debris, ependymal enhancement, and ventricular septations on computed tomography (CT) and magnetic resonance imaging (MRI).[,,] Despite increasing recognition of clinical and imaging features, predictors of rupture remain incompletely defined. Previous studies suggest contributors, including multiloculated morphology, hematogenous etiology, deep location, and immunocompromised state.[,] However, recent literature emphasizes the spatial relationship between the abscess and ventricular wall as a decisive anatomical determinant, yet few studies have quantified this proximity or proposed actionable thresholds for clinical risk stratification. We conducted a combined retrospective–prospective cohort study to investigate predictors and outcomes of IVROBA. Patients treated between January 2018 and December 2023 at two tertiary neurosurgical centers in Moscow (City Clinical Hospital No. 68 and Moscow City Children’s Hospital) were included. Our cohort consists of consecutive, confirmed pyogenic brain abscess cases meeting predefined criteria with complete imaging datasets sufficient for distance quantification and with adequate follow-up. The study was performed across two tertiary neurosurgical centers, including a large pediatric referral hospital in the Russian Federation, which explains the pediatric enrichment. This is a two-center observational cohort study; analyses estimate associations and do not support causal inference. Both institutions serve as referral centers for complex intracranial infections and adhere to uniform diagnostic and management protocols. The study complied with the Declaration of Helsinki and received ethical approval from the Local Ethics Committee of the Voronovskoye Moscow Medical Clinical Center, Moscow, Russia. Written informed consent was obtained from all adult participants or from legal guardians in pediatric or incapacitated patients.