Cavernous sinus thrombosis is a clot blockage of the cavernous sinus, which is located at the base of the skull on both sides of the Turkish saddle.
The function of the cavernous sinus is to venous outflow from the region of the orbits and the brain, as well as the regulation of cerebral circulation.
This pathology is quite rare, but can cause serious consequences. Thrombosis of the sigmoid and transverse sinus also occurs infrequently.
Causes of disease
Cavernous sinus thrombosis can occur for various reasons. Predispose to it:
- infectious diseases occurring in acute form in the area of the maxillary sinuses, ears, teeth and nasopharynx;
- presence of skull injuries;
- diseases of an autoimmune nature (systemic lupus erythematosus, rheumatoid arthritis);
- pathological processes of hemostasis, which are accompanied by increased formation of blood clots (the presence of polycythemia);
- diseases of blood vessels and heart (ischemic heart disease, cardiac arrhythmias, etc.);
- presence of diabetes;
- abortion;
- post-birth period.
The formation of blood clots has an infectious and non-infectious nature. Currently, non-infectious origin is noted to a greater extent. This is due to the frequent use of antibiotics, which prevent serious complications. In this case, it is customary to speak of an idiopathic form of venous thrombosis.
Symptoms of the disease
What are the manifestations of a disease such as cavernous sinus thrombosis? His clinic is quite complicated. Sometimes the disease can be difficult to recognize in the initial stages, as the symptoms are blurred and often similar to signs of other diseases.
Among the main indicators of the disease should be highlighted:
- presence of intense headaches;
- appearance of nausea and vomiting;
- loss and confusion;
- development of coma;
- seizures.
- pain in the neck when bending forward;
- increased body temperature;
- presence of exophthalmos (protrusion of the eyeball forward with subsequent shift to the side).
- development of ophthalmoplegia (paralysis of the eye muscles due to damage to the nerves that regulate eye movement);
- appearance of puffiness in the area of the optic nerve and eyelids;
- vision loss;
- diplopia;
- pain and bluishness of the eye sockets, forehead and base of the nose;
- loss of facial nerve sensation;
- thrombophlebitisfacial veins.
Thrombosis of the cavernous sinus is characterized by subfebrile temperature, asthenia, a feeling of ache in the muscles and joints. In the case of non-infectious blood clots, such symptoms may not appear.
Cerebral symptoms are manifested by meningeal symptoms. As the disease progresses, the seizure threshold increases. In severe cases, the patient may fall into a coma.
The appearance of side symptoms is provoked by the outflow of CSF, increased intracranial pressure, increased swelling of the brain, which ultimately can lead to the death of the patient.
Diagnosis
How is cavernous sinus thrombosis detected? Diagnosis is based on various methods of examination. The patient's complaints and anamnesis are also taken into account.
Migraine, for example, has a number of features:
- Starts acutely and gradually becomes chronic. Pain becomes resistant to painkillers.
- Pain is aggravated by physical exertion and in the supine position. Such a manifestation of a headache suggests that a person has thrombosis of the cirrus sinus.
- When pressing on the Greenstein points, the patient complains of pain. There is swelling of the orbits and protrusion of the eyeball.
All patients with similar neurological symptoms require a visit to the ophthalmologist's office.
On the fundus, you can observe the presence of tortuosity of blood vessels, swellingoptic disc.
From the methods of laboratory research for diagnosis is used:
- CBC.
- blood collection for sterility culture.
- conducting a coagulogram,
- determination of the D-dimer index,
- analysis of cerebrospinal fluid.
Such examinations make it possible to detect an infectious lesion, as well as disorders in the hemostasis system.
From the studies of the instrumental method, it should be noted:
- contrast by CT;
- Magnetic Resonance Imaging;
- cerebral angiography.
Basics of Therapy
Thrombosis of the cavernous sinus, as well as that of the sigmoid and transverse sinus, requires a common treatment approach. Therapy can be conservative and surgical. The last measure is indicated in the advanced state of the disease.
Methods of conservative treatment
How is cavernous sinus thrombosis treated? Treatment with conservative methods has a number of objectives:
- detoxification;
- fight against blood clots;
- elimination of swelling of the brain;
- stopping the infectious process;
- neuroprotective therapy.
Detoxification and antibiotic therapy is used in the presence of thrombosis of infectious origin. Detoxification makes it possible to eliminate and remove toxic substances. For this purpose, infusions with isotonic sodium chloride solution are used,"Reopoliglyukin", "Hemodez".
After taking blood for culture, antibiotics are prescribed. According to the results of the analysis, drugs with a wide spectrum of action are prescribed. In parallel, antibiotics may be prescribed to stop anaerobic infection ("Metronidazole").
To restore normal blood circulation, a blood clot should be eliminated. For this purpose, heparin therapy is carried out. Next, direct anticoagulants are prescribed, which are taken for three months.
After the course, patients are recommended to take such antiplatelet agents as Aspirin, Dipyridamole, Clopidogrel.
In especially severe cases, with the development of swelling of the brain, the pathological process is eliminated by means of diuretics.
Neuroprotective therapy is prescribed during the recovery period. It is carried out with the help of vasodilating agents, as well as neurometabolic agents.
Surgery
Surgery is indicated when conservative methods have not brought the desired result. The cavernous sinus is very difficult to approach due to its anatomical location. Therefore, the operation involves opening the sinuses and sanitation of the primary infectious focus.
Possible Complications
Cavernous sinus thrombosis (a photo of patients suffering from this disease is presented in this article) can lead to serious complications. The earlier diagnostic procedures were performedand therapy is started, the less chance of complications.
Complications are divided into late and early.
From the later it should be noted:
- loss of visual acuity;
- abducens nerve paresis;
- presence of ptosis (drooping eyelid);
- development of arachnoiditis;
- hypopituitarism;
- anisocoria.
From early:
- swelling of the brain;
- partial seizures;
- cerebral infarction.
Often, cavernous sinus thrombosis leads the patient to:
- total blindness.
- stroke (acute circulatory disorder in the brain, which often provokes disability and death);
- violation of the functionality of the pineal gland, which is responsible for inhibition of the release of growth hormones;
- slow down the development of tumors;
- violation of sexual development and behavior.
Such complications occur in about a third of cases.
Preventive measures
In order to avoid falling ill with such an ailment, a number of preventive measures should be observed to help prevent the development of pathology:
- timely treatment of inflammatory processes in the body;
- maintain a he althy lifestyle;
- timely referral to a specialist in diseases that occur in a chronic form and are accompanied by a structural change in the walls of blood vessels and the appearance of increased blood viscosity.
Disease prognosis
Prognosis of the diseaseis directly dependent on timely diagnosis and treatment. The sooner the presence of the disease is established and treatment is started, the higher the chances of recovery.
Methods of treatment used by modern medicine have significantly reduced the threshold for mortality from this disease. The indicator is 20%. Approximately 10% of cases experience recurrence of thrombosis within a year after treatment.
Conclusion
Cavernous sinus thrombosis, the symptoms of which have been described in this article, is a very serious condition. The disease is difficult to treat.
In the vast majority of cases, the pathology causes the patient's disability and often ends in death. Therefore, timely diagnostic procedures and treatment are so important.
