Thrombosis of the cerebral sinuses is a very rare pathology, the neurological and clinical manifestations of which can be very diverse. Unfortunately, at present, doctors have insufficient information regarding the likelihood of developing this disease in the presence of other diseases. By the way, in our country there has not been a single major study on this issue. That is why in most patients sinus thrombosis of the brain is diagnosed late, often already when the disease is at an advanced stage, which cannot but affect the duration of treatment and prognosis. In this regard, therapists and neurologists recommend contacting a medical institution if any alarming symptoms occur. Only on the basis of the results of complex diagnostics, one can suspect the presence of sinus thrombosis andtake all necessary measures in a timely manner.
Pathogenesis
Very often you can hear that the cause of the death of a person was a blood clot. This term refers to a clot of liquid connective tissue, the formation of which occurs in a blood vessel. Thrombus consists of proteins, mainly fibrin. It can be obturating or parietal. In the first case, it is customary to say that the thrombus completely blocks the lumen of the blood vessel, in the second - partially.
The formation of a clot of liquid connective tissue occurs for many reasons. Most often it is:
- Impaired blood outflow.
- Change in vessel wall.
- Increased viscosity of fluid connective tissue.
The basis of the pathogenesis of the disease is a violation of the blood supply to the brain, accompanied by the formation of clots. The latter can be formed in any part of the organ. According to statistical data, thrombosis of the superior sagittal sinus is most often diagnosed. It accounts for 60-98% of cases. In the lateral, direct and cavernous blood clots are found much less frequently. In addition, lesions can be localized in the cortical and deep veins.
Etiology
Despite the fact that the disease is not well understood, medicine knows the causes of sinus thrombosis of the brain. They can be both infectious and non-infectious in nature.
In the first case, the causes of sinus thrombosis are as follows:
- Septic injury.
- Subdural empyema.
- Abscess.
- Meningitis.
- Sinusitis.
- Tit.
- Stomatitis.
- Tonsillitis.
- Septicemia.
- Tuberculosis.
- Endocarditis.
- Hepatitis.
- Measles
- Herpes virus.
- HIV
- Cytomegalovirus.
- Malaria.
- Toxoplasmosis.
- Trichinosis.
- Cryptococcosis.
- Aspergillosis.
Non-infectious causes of sinus thrombosis:
- Various head injuries.
- Condition after a recent neurosurgical intervention.
- Meningioma.
- Cholesteatoma.
- Metastatic neoplasms.
- Obstruction of the internal jugular vein.
- Condition after any surgical treatment.
- Pregnancy.
- Using oral contraceptives.
- Nephrotic syndrome.
- Heart failure.
- Dehydration. Its etiology can be any.
- Malignant neoplasms.
- Thrombophilia (most commonly referred to as a congenital disease).
- Coagulation disorders.
- Crohn's disease.
- Cirrhosis.
- Vasculitis.
- Ulcerative colitis.
- Sarcoidosis.
- Long-term use of drugs, in particular glucocorticosteroids, L-asparginase and aminocaproic acid.
In addition, the risk of sinus thrombosis increases after spinal and epidural anesthesia, as well as after lumbarpuncture.
Symptoms
The clinical picture of the disease can be very diverse. Symptoms of sinus thrombosis and their intensity directly depend on the rate of occlusion of blood vessels.
The onset of the disease can be:
- Sharp. In this case, symptoms develop very quickly, in less than 48 hours.
- Subacute. Clinical manifestations can gradually increase over several days and even a month.
- Chronic. In this case, the intensity of symptoms increases for more than 30 days.
Headache is the main warning sign. With sinus thrombosis, it begins subacutely. The increase in its intensity occurs within a few days. During this time, the headache becomes resistant to the action of analgesics. Patients note that at night it is unbearable, which inevitably leads to sleep disturbances.
Painful sensations very rarely occur suddenly, more often they appear and develop during the day. Their intensity is always much higher during physical exertion. In addition, the headache increases when a person is in a horizontal position. It is often accompanied by neurological symptoms.
During a consultation with a doctor, patients complain not only of a headache, but also of discomfort in the eye area (it occurs due to swelling of the optic nerve head), as well as the presence of convulsive attacks, impaired consciousness, sensory and motor deficit.
Diagnosis
If any warning signs occur (most often it is a severe headache that is resistant to the action of analgesics), you should contact a therapist or neurologist. The specialist will take an anamnesis, conduct a physical examination and issue a referral for a comprehensive examination.
During the diagnosis of a disease, clinical data must always be confirmed by instrumental neuroimaging methods. Most often, doctors recommend that patients undergo an MRI of the head and cerebral vessels and a CT scan. However, the diagnostic value of these methods directly depends on how long ago the disease arose. For example, at the initial stage of pathology development, MRI of the head and cerebral vessels may not be informative. In this regard, the main diagnostic method is CT.
With the help of computed tomography, it is possible not only to detect disorders even at their earliest stage, but also to differentiate them from other conditions that have a similar clinical picture (an example is intracranial hematoma, abscess, brain tumor, etc.).
In the acute stage of the disease, the most informative studies are MRI and CT venography. At the same time, the latter method is more specific and has an increased degree of sensitivity.
In addition, according to clinical guidelines, sinus thrombosis is a pathology, during the diagnosis of which it is necessary to carry out a complete blood count, examination of the fundus and the study of cerebrospinal fluid. The history taking should also be very thorough.
Treatment
The treatment regimen directly depends on the cause that triggered the development of sinus thrombosis. Treatment of an ailment of an infectious nature involves taking broad-spectrum antibiotics, the active components of which are able to penetrate the blood-brain barrier. In addition, the rehabilitation of the focus of pathology by surgical methods is shown.
Antibiotics are given empirically until laboratory results are available. It is worth noting that most often the cause of the development of the disease is the active vital activity of streptococci and staphylococci.
As part of the initial antibiotic therapy, the following drugs may be prescribed:
- III generation cephalosporins (Cefotaxime, Ceftriaxone, Ceftazidime), IV generation (Cefpirome, Cefmetazole).
- Beta-lactam antibiotics. Most often, doctors prescribe Meropenem.
- Glycopeptides (eg Vancomycin).
- Alternative drugs. Experts prefer aminoglycosides and penicillins.
When non-infectious sinus thrombosis is detected, the fight against thrombosis comes to the fore. Currently, the most effective drug is Heparin. It is applied until the patient has visible positive changes. In most cases, heparin therapy is carried out within 1 week.
As part of the fight against thrombosis, "Kurantil" is often prescribed. This is an antiplatelet agent, the active ingredient of which is dipyridamole according to the instructions for use. The price of "Kurantil" isabout 700 rubles, which makes it affordable for most patients.
The dosage regimen is determined by the attending physician on an individual basis. Unless the specialist has indicated otherwise, it is necessary to take the information reflected in the annotation as a basis. 225 mg is the maximum dose according to the instructions for use.
The price of "Kurantil" is quite justified. According to doctors' reviews, this drug is very effective against pathologies of the brain and cardiovascular system associated with thrombosis and circulatory disorders.
Treatment of the disease also involves taking medications to thin the blood. This is due to the fact that the thick liquid connective tissue cannot fully perform its functions, which only aggravates the course of the pathology. During treatment, blood clots also liquefy. Naturally, this has a positive effect on the course of the disease and makes the prognosis more favorable.
The most commonly prescribed blood thinners are Cardiopyrin, Aspirin, Lamifiban, Magnecard. All drugs are selected purely individually based on medical history and diagnostic results.
If conservative methods of therapy are ineffective, the specialist makes a decision regarding the appropriateness of surgical intervention. There are several methods of surgical treatment, but currently bypass surgery remains the most popular. The essence of the method is to create an artificial path around the affected vessel. During the operation, open access is used, in connection with whichthe intervention is performed under general anesthesia.
Features of pathology in children
Impaired blood supply to the brain is an urgent problem not only among the adult population. According to statistics, thrombosis of the cerebral sinuses is diagnosed in 2 out of 100,000 children annually. Moreover, the superior sagittal sinus is most often affected. Slightly less common thrombosis of the lateral.
Main causes of disease in children:
- Genetic predisposition.
- Bacterial sepsis.
- Chickenpox
- Purulent meningitis.
- Severe dehydration.
- Congenital heart disease.
- Liver disease.
Clinical manifestations of the disease directly depend on the age of the child. At the same time, they can be expressed both weakly (drowsiness, excitability, appetite disturbances) and strongly (coma). In infants, sinus thrombosis is most often manifested by generalized convulsions, depression and fever.
At older age, the following symptoms appear:
- Headache.
- Vomiting.
- Congestion in the fundus.
Treatment of pathology in children involves taking anticoagulants, thrombolytics and antiplatelet agents.
Features of the disease in pregnant women and women in labor
According to statistics, sinus thrombosis is diagnosed in approximately 1-4 cases per 10,000 births. In this case, the disease is most often detected in women of young and middle age.
The main causes of the development of the disease in pregnant women and women in childbirth:
- Inflammatory processes in the sinuses, ear, face.
- Neoplasms of both benign and malignant nature.
- Hereditary mutations (e.g. Leiden factor).
- Leukemia.
- Polycythemia.
- Behçet's disease.
- Antiphospholipid syndrome.
The first symptom is a headache. Over time, nausea, vomiting, convulsive seizures join it. Possible disturbances of consciousness, in particular coma.
Treatment of an ailment in pregnant women and women in childbirth involves intensive care with the help of the above drugs. In addition, measures are being taken to correct intracranial hypertension and relieve seizures.
Features of food
Each patient after the treatment should know which foods prevent the formation of blood clots. In addition, dietary adjustments can be considered as primary prevention of the disease.
The menu should include foods that promote blood thinning and prevent the formation of clots of liquid connective tissue.
These include:
- Vegetables and fruits rich in vitamin C (citrus fruits, grapes, sour apples, lingonberries, blueberries, plums, cherries, apricots, peaches, garlic, onions).
- Berries (raspberries, blackberries, strawberries, blueberries, currants). They can be eaten fresh or made into juices and smoothies.
- Seedlings of legumes and cereals (peas, oats, buckwheat,wild rice). Against the background of their regular use, blood vessels are cleansed.
- Tomatoes.
- Bulgarian pepper.
- Green peas.
- White cabbage.
- Slightly s alted cucumbers.
- Carrot.
- Bee products, especially honey.
- Ginger.
- Dill.
- Parsley.
- Fuck.
- Cinnamon.
- Vegetable oils.
For the duration of the diet, you should abandon foods that negatively affect blood circulation, cause an increase in platelet growth and increase the risk of blood clots.
The following products must be excluded from the menu:
- Nuts.
- High-fat cheeses.
- Bananas.
- Potatoes.
- Sweet drinks.
- Strong tea.
- Marinades.
- Canned food.
- Meat.
- Milk.
- Alcohol.
Forecast
The outcome of the disease directly depends on the severity of the patient's condition, the timeliness of diagnosis and treatment.
The following prognostic signs are unfavorable:
- Depression of consciousness.
- Deep coma.
- Sepsis.
- Epileptic seizures that are extremely difficult to stop.
- Hemorrhagic heart attacks.
- Pulmonary embolism.
According to available data, complete recovery occurs in approximately 50-75% of patients. Residual effects are diagnosed in approximately 29% of cases. Lethaloutcome occurs in 5-33% of patients.
With late diagnosis and prolonged lack of treatment, the risk of developing the following complications increases significantly:
- Swelling of brain matter.
- Venous infarction.
- Purulent meningitis.
- Retinal vein thrombophlebitis.
- Metastatic lung abscesses.
- Epilepsy.
- Brain abscess.
- Septic pneumonia.
In order to prevent the onset of negative consequences that pose a danger not only to life, but also to he alth, it is necessary to contact a medical institution as soon as possible when the first alarming symptoms appear. A regular and intense headache, which is difficult to stop with analgesics or is completely resistant to them, should be especially alert.
In addition, as part of the primary prevention of the disease, it is recommended to lead a he althy lifestyle, which implies regular physical activity. Physical activity prevents the formation of blood clots. It is also important to make adjustments to the diet, the menu should be balanced.
In closing
Sinus thrombosis is a very rare form of circulatory disorders in the brain, the course of which is accompanied by a deterioration in the outflow of fluid connective tissue due to blockage of blood vessels by blood clots. The main symptom of the disease is headache. It can occur acutely or increase in intensity over time. To make an accurate diagnosis, it is necessary to undergo a comprehensive examination. Currently, CT is the most clinically relevant technique in terms of informativeness.
