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 do not have enough information regarding the likelihood of developing this ailment in the presence of other diseases. By the way, in our country there has not been a single major study devoted to this problem. That is why in most patients, sinus thrombosis of the brain is diagnosed late, often already when the disease is at a late 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 a comprehensive diagnosis can a patient be suspected of having sinus thrombosis and take all necessary measures in a timely manner.
Pathogenesis
You can often hear that a blood clot became the cause of the death of a person. This term refers to a clot of liquid connective tissue, the formation of which occurs in a blood vessel. A blood clot consists of proteins, mainly fibrin. It can be obstructive or parietal. In the first case, it is customary to say that a blood clot completely blocks the lumen of a blood vessel, in the second - partially.
The formation of a clot of liquid connective tissue occurs for many reasons. Most often it is:
- Violation of the outflow of blood.
- Change in vessel wall.
- Increased viscosity of fluid connective tissue.
The pathogenesis of the disease is based on a violation of the blood supply to the brain, accompanied by the formation of clots. The latter can form in any part of the organ. According to statistics, thrombosis of the upper sagittal sinus is most often diagnosed. It accounts for 60-98% of cases. In the lateral, direct and cavernous thrombi are found much less often. In addition, lesions can be localized in the cortical and deep veins.
Etiology
Despite the fact that the disease has not been studied well enough, medicine knows the causes of sinus thrombosis of the brain. They can have both infectious and non-infectious nature.
In the first case, the causes of sinus thrombosis are as follows:
- Septic trauma.
- Subdural empyema.
- Abscess.
- Meningitis.
- Sinusitis.
- Otitis.
- Stomatitis.
- Tonsillitis.
- Septicemia.
- Tuberculosis.
- Endocarditis.
- Hepatitis.
- Measles.
- Herpes virus.
- HIV
- Cytomegalovirus.
- Malaria.
- Toxoplasmosis.
- Trichinosis.
- Cryptococcosis
- Aspergillosis
Non-infectious causes of sinus thrombosis:
- Various types of head injuries.
- Condition after a recent neurosurgical intervention.
- Meningioma
- Cholesteatoma.
- Metastatic neoplasms.
- Obstruction of the internal jugular vein.
- Condition after any surgical treatment.
- Pregnancy.
- Acceptance of oral contraceptives.
- Nephrotic syndrome.
- Heart failure.
- Dehydration. Her etiology can be any.
- Malignant neoplasms.
- Thrombophilia (most often it is said that there is a congenital illness).
- Coagulation disorders.
- Crohn's disease.
- Cirrhosis.
- Vasculitis
- Ulcerative colitis.
- Sarcoidosis
- Long-term administration of drugs, in particular glucocorticosteroids, L-asparginase and aminocaproic acid.
In addition, the risk of developing sinus thrombosis increases after spinal and epidural anesthesia, as well as after lumbar puncture.
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, the 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 the symptoms increases in more than 30 days.
The main warning sign is a headache. With sinus thrombosis, it begins subacute. 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 intolerable, 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, a headache intensifies when a person is in a horizontal position. Often it is 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 deficits.
Diagnostics
If you have any warning signs (most often it is a pronounced headache, resistant to the action of analgesics), you need to contact a therapist or neurologist. The specialist will collect an anamnesis, conduct a physical examination and draw up a referral for a comprehensive examination.
During the diagnosis of the disease, clinical data should always be confirmed by instrumental methods of neuroimaging. Most often, doctors recommend that patients undergo MRI of the head and blood vessels of the brain and CT. However, the diagnostic value of these methods directly depends on how long the disease arose. For example, at the initial stage of the development of pathology of MRI of the head and blood vessels of the brain, it may not be informative. In this regard, the main diagnostic method is CT.
Using computed tomography, you can not only detect violations even at their earliest stages, but also 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. Moreover, the latter method is more specific and is characterized by an increased degree of sensitivity.
In addition, according to clinical recommendations, sinus thrombosis is a pathology, during the diagnosis of which it is necessary to conduct a general blood test, examination of the fundus and a study of cerebrospinal fluid. A medical history should also be very thorough.
Treatment
The treatment regimen directly depends on what reason triggered the development of sinus thrombosis. Treatment of a disease of an infectious nature involves the use of broad-spectrum antibiotics, the active components of which are able to penetrate the blood-brain barrier. In addition, sanitation of the focus of the pathology by surgical methods is indicated.
Prior to obtaining laboratory results, antibiotics are prescribed empirically. It should be noted that most often the cause of the development of the disease is the active life of streptococci and staphylococci.
As part of the initial antibiotic therapy, the following drugs can be prescribed:
- Cephalosporins of the III generation ("Cefotaxime", "Ceftriaxone", "Ceftazidime"), IV generation ("Cefpirome", "Cefmetazole").
- Beta-lactam antibiotics. Most often, doctors prescribe Meropenem.
- Glycopeptides (for example, Vancomycin).
- Alternative drugs. Specialists prefer aminoglycosides and penicillins.
With the detection of non-infectious sinus thrombosis, the fight against thrombosis comes to the fore. Currently, the most effective drug is Heparin. It is used until the patient has visible positive changes. In most cases, heparin therapy is carried out for 1 week.
In the framework of the fight against thrombosis, Curantil is often prescribed. This is an antiplatelet agent, the active component of which is dipyridamole according to the instructions for use. The price of Curantil is about 700 rubles, which makes it affordable for most patients.
The dosage regimen is determined by the attending physician individually. Unless the specialist has indicated otherwise, it is necessary to accept the information reflected in the annotation as a basis. 225 mg - maximum dose according to the instructions for use.
The price of Curantil is quite justified. According to doctors, 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 thick liquid connective tissue cannot fully perform its functions, which only exacerbates the course of 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.
Most often, the following blood thinners are prescribed: Cardiopyrine, Aspirin, Lamifiban, Magnecard. All drugs are selected purely individually based on history and diagnostic results.
With the ineffectiveness of conservative methods of therapy, the specialist decides on the advisability 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 bypassing the affected vessel. During the operation, open access is used, in connection with which the intervention is carried out under general anesthesia.
Features of pathology in children
Disorders of the blood supply to the brain are an urgent problem not only among the adult population. According to statistics, cerebral sinus thrombosis is diagnosed in 2 out of 100,000 children annually. Moreover, the upper sagittal sinus is most often affected. Lateral thrombosis is somewhat less common.
The main causes of the development of the disease in children:
- Genetic predisposition.
- Bacterial sepsis.
- Chickenpox.
- Purulent meningitis.
- Severe dehydration.
- Congenital heart disease.
- Liver disease.
The clinical manifestations of the disease directly depend on the age of the child. At the same time, they can be expressed both weakly (drowsiness, irritability, appetite disturbances), and strongly (coma). In infants, sinus thrombosis is most often manifested by generalized convulsions, depression and fever.
At an older age, the following symptoms appear:
- Headache.
- Vomiting
- Stagnation in the fundus.
Treatment of pathology in children involves the use of anticoagulants, thrombolytics and antiplatelet agents.
Features of the disease in pregnant women and women in childbirth
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 area of sinuses of the nose, ear, face.
- Neoplasms of both benign and malignant nature.
- Hereditary mutations (e.g., Leiden factor).
- Leukemia.
- Polycythemia.
- Behcet's disease.
- Antiphospholipid syndrome.
The first symptom is a headache. Over time, nausea, vomiting, convulsive seizures join it. Possible impaired consciousness, in particular coma.
Treatment of the disease in pregnant women and women in childbirth involves conducting intensive therapy with the help of the above drugs. In addition, measures are being taken to correct intracranial hypertension and relieve seizures.
Power Features
After treatment, each patient should know which products prevent blood clots. In addition, dietary adjustment can be considered as a primary prevention of the disease.
The menu must include products that contribute to blood thinning and prevent the formation of clots of liquid connective tissue.
These include:
- Vitamin C-rich vegetables and fruits (citrus fruits, grapes, sour apples, lingonberries, blueberries, plums, cherries, apricots, peaches, garlic, onions).
- Berries (raspberries, blackberries, strawberries, blueberries, currants). They can be consumed fresh or made from juices and smoothies.
- Sprouts of legumes and grains (peas, oats, buckwheat, wild rice). Against the background of their regular use, blood vessels are cleansed.
- Tomatoes
- Bell pepper.
- Green pea.
- White cabbage.
- Lightly salted cucumbers.
- Carrot.
- Beekeeping products, especially honey.
- Ginger.
- Dill.
- Parsley.
- Horseradish.
- Cinnamon.
- Vegetable oils.
At the time of the diet, foods that negatively affect blood circulation, cause an increase in platelet growth and increase the risk of blood clot formation should be abandoned.
The following products should 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:
- Oppression of consciousness.
- Deep coma.
- Sepsis.
- Epileptic seizures that are extremely difficult to stop.
- Hemorrhagic heart attacks.
- Pulmonary embolism.
According to available data, a full recovery occurs in approximately 50-75% of patients. Residual effects are diagnosed in approximately 29% of cases. Fatal outcome occurs in 5-33% of patients.
With an untimely diagnosis and a long absence of treatment, the risk of developing the following complications significantly increases:
- Swelling of the substance of the brain.
- Venous infarction.
- Purulent meningitis.
- Thrombophlebitis of retinal veins.
- Metastatic abscesses in the lungs.
- Epilepsy.
- Brain abscess.
- Septic pneumonia.
In order to prevent the onset of negative consequences that are dangerous not only for life but also for health, 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 healthy lifestyle, involving regular physical activity. Exercise prevents the formation of blood clots. It is also important to make adjustments to the diet, the menu should be balanced.
Finally
Sinus thrombosis is a very rare form of circulatory disturbance in the brain, the course of which is accompanied by a deterioration in the outflow of fluid connective tissue due to clogging of blood vessels by blood clots. The main symptom of the disease is a headache. It can occur acutely or increase in intensity over time. To make an accurate diagnosis, you need to undergo a comprehensive examination. Currently, CT is the most clinically significant technique from the point of view of informational content.