Bacterial meningitis and subsequent pyogenic ventriculitis in patients with complex medical histories and prior cranial surgeries presents significant diagnostic and management challenges. While typical signs of infection such as fever and leukocytosis may be present, secondary complications including seizure, respiratory failure, and pyogenic ventriculitis can complicate the clinical course. This case illustrates the need for comprehensive evaluation and tailored intervention in immunocompromised patients presenting with atypical infection. The case involved a 63-year-old female with a prior craniotomy and multiple comorbidities, presenting to the Emergency Department with acute encephalopathy and suspected bacterial meningitis. Upon transfer to the ICU following acute onset seizure with subsequent respiratory failure, the patient underwent diagnostic workup including lumbar puncture continuous electroencephalography (cEEG), and MRI. Management was initiated with broad-spectrum antibiotics (ceftriaxone, vancomycin) and supportive care. Diagnostic testing revealed bacterial meningitis with positive blood cultures & MRI evidence of pyogenic ventriculitis. After intubation and initial seizure management, the patient showed clinical improvement with IV antibiotics, levetiracetam, and supportive care. ABG normalization and clinical improvement led to successful extubation and discharge by hospital day 9. Follow-up therapy included home-administered ceftriaxone. This case underscores the importance of rapid intervention in bacterial meningitis & its complications, particularly for patients with prior neurological surgeries. Continuous monitoring, early neurologic consultation, early neurosurgical evaluation, and timely antimicrobial therapy can mitigate complications and support positive outcomes. The insights gained reinforce the need for vigilance in managing similar high-risk cases in critical care settings.