Cavernous sinus thrombosis is a blockage in the thrombus 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 the venous outflow from the area of the orbits and the brain, as well as the regulation of cerebral circulation.
Such a pathology is quite rare, but can cause serious consequences. Sigmoid and transverse sinus thrombosis is also rare.
Causes of the disease
Cavernous sinus thrombosis can form due to various reasons. They predispose to him:
- infectious diseases that occur in acute form in the region of the maxillary sinuses, ears, teeth and nasopharynx;
- the presence of skull injuries;
- autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis);
- pathological processes of hemostasis, which are accompanied by an increased formation of blood clots (the presence of polycemia);
- vascular and heart diseases (ischemic heart disease, heart rhythm disturbance, etc.);
- the presence of diabetes;
- abortion;
- the period after the birth of the baby.
The formation of blood clots has an infectious and non-infectious nature. Currently, non-infectious origin is more marked. This is due to the frequent use of antibiotics that prevent serious complications. In this case, it is customary to talk about the 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 worn out and often similar to signs of other diseases.
Among the main indicators of the disease should be highlighted:
- the presence of intense headaches;
- the appearance of nausea and vomiting;
- loss of consciousness and confusion;
- coma development;
- the occurrence of seizures.
- pain in the neck when bending forward;
- increase in body temperature;
- the presence of exophthalmos (protrusion of the eyeball forward, followed by a shift to the side).
- the development of ophthalmoplegia (paralysis of the eye muscles with damage to the nerves that regulate eye movement);
- the appearance of puffiness in the optic nerve and eyelids;
- decreased vision;
- diplopia;
- pain and cyanosis of the orbits, forehead and base of the nose;
- loss of sensitivity of the facial nerves;
- thrombophlebitis of the facial veins.
Cavernous sinus thrombosis is characterized by the presence of subfebrile temperature, asthenia, a feeling of aching in the muscles and joints. In the case of blood clots of a non-infectious nature, such symptoms may not occur.
Cerebral symptoms are manifested by meningeal symptoms. With the development of the disease, the threshold of seizure increases. In severe cases, the patient may fall into a coma.
The appearance of side symptoms is provoked by the outflow of cerebrospinal fluid, an increase in intracranial pressure, an increase in swelling of the brain, which ultimately can lead to the death of the patient.
Diagnosis
How is thrombosis of the cavernous sinus detected? Diagnosis is based on various methods of examination. Patient complaints and medical history are also taken into account.
Migraine, for example, has several features:
- It begins acutely and gradually takes on a chronic form. The pain becomes resistant to painkillers.
- Pain sensations intensify with physical exertion and in a supine position. This manifestation of a headache suggests that a person has cirrus sinus thrombosis.
- When pressing on Greenstein's points, the patient complains of pain. Swelling of the eye sockets and protrusion of the eyeball appears.
All patients with similar symptoms of a neurological nature require a visit to the ophthalmologist’s office.
On the fundus you can observe the presence of tortuosity of the vessels, swelling of the optic disc.
Of the methods of laboratory research for the diagnosis used:
- general blood analysis.
- collection of blood for inoculation for sterility.
- coagulation,
- determination of the indicator of D-dimer,
- cerebrospinal fluid analysis.
Such examinations make it possible to identify an infectious lesion, as well as violations in the hemostatic system.
Of the studies using the instrumental method, it should be noted:
- contrast by CT;
- magnetic resonance imaging ;
- cerebral angiography.
Therapy Basics
Cavernous sinus thrombosis, as well as sigmoid and transverse, requires common approaches to treatment. Therapy can be conservative and surgical. The last measure is indicated in the advanced state of the disease.
Conservative treatment methods
How is thrombosis of the cavernous sinus stopped? Conservative treatment has a number of objectives:
- detoxification;
- the fight against the formation of blood clots;
- elimination of cerebral edema;
- relief of the infectious process;
- neuroprotective therapy.
Detoxification and antibiotic therapy are used in the presence of thrombosis of an infectious origin. Detoxification makes it possible to eliminate and eliminate toxic substances. For this purpose, infusions are used with an isotonic solution of sodium chloride, Reopoliglyukin, Gemodez.
After taking blood, antibiotics are prescribed for culture. According to the results of the analysis, drugs with a wide spectrum of action are prescribed. In parallel, antibiotics can be prescribed to relieve anaerobic infections (Metronidazole).
To restore normal blood circulation, a blood clot should be eliminated. To this end, heparin therapy is performed. 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 cerebral edema, 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.
Surgical intervention
Surgical operation is indicated in the case when conservative methods did not bring the proper result. It is very difficult to find an approach to the cavernous sinus due to its anatomical location. Therefore, the operation involves opening the sinuses and debridement 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 sooner diagnostic procedures have been carried out and therapy has been started, the less likely there are complications.
Complications are divided into late and early.
Of the later, it should be noted:
- loss of visual acuity;
- paresis of the abducent nerve ;
- the presence of ptosis (drooping eyelids);
- the development of arachnoiditis;
- hypopituitarism;
- anisocoria.
From the early:
- swelling of the brain;
- partial seizures;
- cerebral infarction.
Often, cavernous sinus thrombosis leads the patient to:
- complete blindness.
- a stroke (acute circulatory disturbance in the brain, which often provokes disability and death);
- violation of the functionality of the pineal gland, responsible for inhibition of the release of growth hormones;
- slowing down the development of tumors;
- violation of sexual development and behavior.
Such complications are noted in about a third of cases.
Preventative measures
In order to avoid a disease with such an ailment, a number of preventive measures should be observed that help prevent the development of pathology:
- timely treatment of inflammatory processes in the body;
- compliance with a healthy lifestyle;
- timely access to a specialist for diseases that occur in a chronic form and accompanied by a structural change in the walls of blood vessels and the appearance of increased blood viscosity.
Disease prognosis
The prognosis of the disease is directly dependent on timely diagnosis and therapy. The sooner the presence of the disease is established and treatment is started, the higher the chances of recovery.
The treatment methods employed by modern medicine have significantly reduced the mortality threshold for this disease. The rate is 20%. In approximately 10% of cases, re-emergence of thrombosis is observed within a year after the therapy.
Conclusion
Cavernous sinus thrombosis, the symptoms of which were described in this article, is a very serious disease. The disease is difficult to treat.
In the vast majority of cases, pathology causes a patient's disability and often results in death. Therefore, the timely conduct of diagnostic procedures and treatment is so important.