Cavernous sinus thrombosis: symptoms, diagnosis, treatment

Thrombosis of the cavernous sinus is a clogged 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 in the venous outflow from the orbit and brain area, as well as the regulation of cerebral circulation.

Such a pathology is rare, but it can cause serious consequences. Also, thrombosis of the sigmoid and transverse sinus is infrequent.

Causes of the disease

Thrombosis of the cavernous sinus can be formed for various reasons. To him predispose:

• Infectious diseases occurring in an acute form in the region of the maxillary sinuses, ears, teeth and nasopharynx;
• Presence of trauma to the skull;
• Diseases of autoimmune nature (systemic lupus erythematosus, rheumatoid arthritis);
• Pathological processes of hemostasis, which are accompanied by increased formation of thrombi (the presence of polycemia);
• Diseases of blood vessels and heart (ischemic heart disease, heart rhythm disturbance, etc.);
• Presence of diabetes mellitus;
• abortion;
• Period after the birth of the child.

The formation of thrombi is of an infectious and non-infectious nature. At present, non-infectious origin is more marked. This is due to the frequent use of antibiotics, preventing severe complications. In this case, it is customary to talk about the idiopathic form of venous thrombosis.

Symptomatic of the disease

What are the manifestations of such a disease, as a cavernous sinus thrombosis? His clinic is quite complicated. Sometimes the ailment can be difficult to recognize in the initial stages, because the symptoms are worn out and often similar to the signs of other diseases.

Among the main indicators of the disease should be allocated:

• The presence of intense headaches;
• The appearance of nausea and vomiting;
• Loss and confusion;
• Development of coma;
• Occurrence of seizures.
• Pain in the neck when bent forward;
• Increased body temperature;
• Presence of exophthalmos (protrusion of the eyeball forward and subsequent displacement to the side).
• Development of ophthalmoplegia (paralysis of the eye muscles in the defeat of nerves that regulate the movement of the eyes);
• The appearance of swelling in the optic nerve and eyelids;
• Decreased vision;
• Diplomacy;
• Painful sensations and cyanosis of the eye sockets, forehead and the base of the nose;
• Loss of sensitivity of facial nerves;
• Thrombophlebitis of facial veins.

Thrombosis of the cavernous sinus is characterized by the presence of subfebrile temperature, asthenia, a feeling of aches in the muscles and joints. In the case of the formation of non-infectious thrombi, such symptoms may not appear.

General cerebral symptoms are manifested by meningeal symptoms. When the disease develops, the threshold of convulsivity increases. In especially severe cases, the patient may fall into a coma.

Occurrence of adverse symptoms is triggered by outflow of cerebrospinal fluid, increased intracranial pressure, increased swelling of the brain, which ultimately can lead to death of the patient.

Diagnosis

How is thrombosis of the cavernous sinus revealed? Diagnosis is based on various methods of examination. Also, complaints of the patient and anamnesis are taken into account.

Migraine, for example, has a number of features:

• It begins acutely and gradually acquires a chronic form. Pain becomes resistant to pain medications.
• Painful sensations increase with physical activity and in a supine position. This manifestation of a headache suggests that a person has a thrombosis of the pinnate sinus.
• When pressing on the points of Greenstein, the patient complains of pain. There is swelling of the eye sockets and protrusion of the eyeball.

All patients with a similar symptom of neurological nature require a visit to the office of an ophthalmologist.

On the fundus it is possible to observe the presence of the tortuosity of the vessels, edema of the optic nerve disk.

From the methods of laboratory research for the diagnosis is used:

• general blood analysis.
• Collection of blood for seeding for sterility.
• Carrying out a coagulogram,
• Determination of the D-dimer index,
• Analysis of cerebrospinal fluid.

Such examinations make it possible to identify infectious lesions, as well as disorders in the hemostasis system.

From research by instrumental method it should be noted:

• Contrast by means of CT;
• Magnetic resonance imaging;
• Cerebral angiography.

Basics of therapy

Thrombosis of the cavernous sinus, as well as sigmoid and transverse, requires common approaches to treatment. Therapy can be conservative and surgical. The last measure is shown when the disease state is neglected.

Methods of conservative treatment

How does cavernous sinus thrombosis stop? Treatment conservative methods pursues a number of tasks:

• Detoxification;
• Fighting blood clots;
• Elimination of edema of the brain;
• Relief of the infectious process;
• Neuroprotective therapy.

Detoxification and antibiotic therapy is used in the presence of thrombosis of an infectious origin. Detoxification makes it possible to eliminate and eliminate toxic substances. To this end, infusions are used with isotonic sodium chloride solution, "Reopoliglyukin", "Hemodesum".

After taking blood for seeding, antibiotics are prescribed. Based on the results of the analysis, preparations with a wide spectrum of action are prescribed. In parallel, antibiotics can be prescribed to stop anaerobic infections ("Metronidazole").

To restore normal blood circulation, a thrombus should be removed. To this end, heparin is administered. Further, direct anticoagulants are prescribed, which are taken for three months.

After the course, patients are recommended to take such antiplatelet agents as "Aspirin", "Dipiridamol", "Klopidogrel".

In especially severe cases with the development of edema of the brain, the pathological process is eliminated by diuretics.

Neuroprotective therapy is prescribed during the recovery period. It is carried out with the help of tools that promote the expansion of blood vessels, as well as neurometabolic drugs.

Operative intervention

The surgical operation is indicated in the case when conservative methods did not bring the proper result. To the cavernous sinus it is very difficult to find an approach because of its anatomical location. Therefore, the operation involves opening the sinuses of the nose and sanation of the primary infectious focus.

Possible complications

Thrombosis of the cavernous sinus (photos of patients suffering from this disease, presented in this article) can lead to serious complications. The earlier the diagnostic procedures were performed and the therapy started, the less likely the complications.

Complications are divided into late and early.

From the later it should be noted:

• Loss of visual acuity;
• Paresis of the nerve ;
• Presence of ptosis (omission of the eyelid);
• Development of arachnoiditis;
• Hypopituitarism;
• Anisocoria.

From early:

• Swelling of the brain;
• Partial seizures;
• Cerebral infarction.

Often, thrombosis of the cavernous sinus leads the patient to:

• Complete blindness.
• Stroke (acute impairment of blood circulation in the brain, which often provokes disability and death);
• Disruption of the functionality of the pineal gland responsible for inhibition of growth hormone release;
• Slowing down the development of tumors;
• Violation of sexual development and behavior.

Such complications are noted in about a third of cases.

Preventive measures

To avoid this disease, a number of preventive measures should be taken to prevent the development of pathology:

• Timely treatment of inflammatory processes in the body;
• Adherence to 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 high blood viscosity.

Prognosis of the disease

The prognosis of the disease is directly dependent on timely diagnosis and therapy. The earlier the presence of the disease is established and the treatment is started, the higher the chances of recovery.

The methods of treatment used by modern medicine have made it possible to substantially reduce the death rate from this disease. The indicator is 20%. Approximately in 10% of cases there is a repeated occurrence of thrombosis within a year after the spent therapy.

Conclusion

The cavernous sinus thrombosis, the symptoms of which have been described in this article, is a very serious disease. The illness is difficult to treat.

In the vast majority of cases, pathology causes a patient's disability and often ends in a fatal outcome. Therefore, timely carrying out of diagnostic procedures and treatment is so important.