CEREBRAL VENOUS SINUS THROMBOSIS

WHAT IS CEREBRAL VENOUS SINUS THROMBOSIS

Presence of blood clot in the cerebral dural sinuses which drains blood from the brain is called Cerebral Venous Sinus Thrombosis.

Advertisements

CAUSES

  1. Infection from the middle ear, mastoid, danger area of the face and paranasal air sinuses.
  2. Intracranial infection or trauma.
  3. Severe anemia, congenital cyanotic heart disease, polycythaemia, sickle cell anemia, enteric fever are rare causes.
  4. Dehydration.
  5. Pregnancy, puerperium and intake of contraceptive pills.

CLINICL FEATURES

1.Venous Thrombosis

There may be fever, focal epilepsy and sometimes hemiparesis.

2.Dural Venous Sinus Thrombosis

3.Transverse Sinus Thrombosis

Fever coming with chill and rigour, headache, vomiting and papilloedema may be present. Venous congestion over the mastoid process and tenderness in the neck may be present. the latter is due to extension of inflammation to the jugular vein. Convulsion and hemiparesis on the opposite side may be present.

4.Cavernous Sinus Thrombosis

Pain in and around the eyes extending into the forehead, gradualy proptosis, chemosis of conjunctivae and swelling of eyelids develop. Fever may be present. There may be oculomotor palsies and ophthalmoscopic examination reveals papilloedema, At the beginning, the features are usually unilateral but as the phlebitis extends through anterior and posterior intercavernous sinuses to the opposite cavernous sinus the features become bilateral. This usually results from infection in the danger area of the face and paranasal a sinuses.

 5.Superior Sagittal sinus Thrombosis

Fever with chill and rigor, focal epilepsy, headache, vomiting and delirium may be present. Monoplegia with extensor planter reflex may develop. Papilloedema is sometimes present. Otitic hydrocephalus may develop.

INVESTIGATIONS OF CEREBRAL VENOUS SINUS THROMBOSIS

Venous thrombosis can be confirmed by CT scan, MRI, MR Venography or angiography

COMPLICATION

The main clinical complication of Cerebral Venous Sinus Thrombosis is abscess.

TREATMENT

Control of infection by appropriate antibiotics and chemotherapeutic agents should be done. It should be ligated. Anticonvulsants may be used.

Dexamethasone 4 mg 3 times a day may be helpful to reduce cerebral oedema and the intracranial pressure. Anticoagulants may sometimes be given cautiously.