Cavernous Sinus Thrombosis

Cavernous Sinus Thrombosis

In the case of a cavernous sinus thrombosis, the cavernous sinus is closed by a blood clot or a blood clot. It is a life-threatening disease.

What is cavernous sinus thrombosis?

The term cavernous sinus thrombosis refers to a partial or complete occlusion of the cavernous sinus. For cachexia definitions, please visit definitionexplorer.com.

The cavernous sinus is a venous blood vessel in the brain. It belongs to the sinus durae matris and is located on both sides of the Turkish saddle ( Sella turcica ). It receives the venous blood from the sphenoparietal sinus, the superior ophthalmic vein, and the inferior ophthalmic vein. Four cranial nerves and the internal carotid artery, an artery that supplies the brain, run in the wall of the cavernous sinus. The four cranial nerves are:

  • Nerve oculomotor
  • Optical Nerve
  • Maxillary nerve
  • Nervous trochlearis.

Causes

Cavernous sinus thrombosis usually develops on the basis of bacterial inflammation of the sinuses. The pathogens usually reach the cavernous sinus via the bloodstream from the frontal sinus (frontal sinusitis ) or from the sphenoid sinus ( sphenoidal sinusitis ). But bacterial inflammation of the soft tissues of the upper facial area can also spread to the cavernous sinus. Possible causative diseases here are furuncles or erysipelas.

Other causes include mastoiditis and meningitis. A bacterial cause is always referred to as septic sinus vein thrombosis. A cavernous sinus thrombosis can also be caused by diseases that are associated with increased blood clotting. These include, for example, polycythemia or antithrombin deficiency. Pregnant women have a higher risk of developing sinus vein thrombosis. Medications such as hormonal contraceptives or cortisone preparations also increase the risk.

Symptoms, Ailments & Signs

A cavernous sinus thrombosis develops rather slowly. Early signs are pressure pain in the corner of the nose and blurred vision. Signs of congestion can occur in the eye area. The side on which the thrombosis is located is affected. The eye is red or swollen. It may protrude from the eye socket ( exophthalmos ).

Due to paralysis of the eye muscles, the eyes can only be moved to a limited extent. Those affected see double vision. The symptoms are accompanied by non-specific general symptoms such as nausea, vomiting, fever and chills.

Later the headache increases. Neck pain can also occur. The pain radiates into the arms or radiates from one temple over the entire forehead to the other temple. Edema occurs in the area of ​​the eyelids and the nasolabial fold. Epileptic seizures may occur. Psychotic symptoms or personality changes are also possible.

In the full picture, those affected have a very high fever. This is also referred to as septic temperatures. The eyes protrude significantly, and there is a risk of loss of vision due to the disturbances in eye mobility. The conjunctiva may also be swollen (chemosis). Paralysis can occur as well as sensory disturbances and clouding of consciousness.

In late stages there is a risk of death from increased intracranial pressure. The main symptoms of increased intracranial pressure are severe headaches, vomiting and papilla congestion. If these three symptoms occur together, one speaks of an intracranial pressure triad. The cavernous sinus syndrome threatens as a complication. This clinical picture is characterized by the complete failure of the cranial nerves that run through the wall of the cavernous sinus.

A cavernous sinus fistula can also develop. This creates a connection between the internal carotid artery or the external carotid artery and the cavernous sinus. This results in a reversal of flow with venous outflow disorders and a lack of supply of oxygen-rich blood to the vessels in the brain.

In the case of a cavernous sinus thrombosis, there is also a risk of small cerebral hemorrhages because the blood flow is disrupted and the thin walls of the sinus are heavily burdened by the accumulated blood.

Diagnosis & course of disease

The diagnosis of cavernous sinus thrombosis is quite difficult. The signs of the disease are not clear and can also be caused by other diseases such as an abscess or encephalitis. If a thrombosis is suspected in this area, the D-dimer level in the blood can be determined. But even this can only substantiate the suspicion, but not confirm it. A positive Griesinger sign may be observed.

Due to the unclear symptoms, early cross-sectional imaging is recommended if sinus vein thrombosis is suspected. Computed tomography or magnetic resonance imaging can make infarcts or bleeding visible. The clots can also be visualized well with contrast media. In exceptional cases, angiographies are also performed.

Complications

Cavernous sinus thrombosis can result in serious complications and can even be fatal if treated inadequately or not at all. Initially, the blood clot initially causes visual disturbances and paralysis of the eye muscles. As a result, the eyesight is severely impaired and the risk of an accident increases. Epileptic seizures may also occur, which are also associated with an increased risk of injury.

In addition, in some cases, psychotic symptoms and personality changes may occur. It can also lead to high fever and subsequent circulatory failure. In the further course there is acute danger to life due to the increased intracranial pressure. A typical complication is the cavernous sinus syndrome, in which the cranial nerves and thus all neurological and mental functions fail.

A cavernous sinus fistula can also develop. In late stages, the impaired blood flow causes small cerebral hemorrhages, which are associated with serious complications. Drug therapy for cavernous sinus thrombosis carries the risk of side effects and interactions. Since very high doses are usually administered, there is a risk of permanent kidney and liver damage. Some patients also develop an addiction or form a tolerance to the respective active ingredient.

When should you go to the doctor?

Cavernous sinus thrombosis must always be treated by a doctor. In the worst case, this disease can lead to the death of the person affected, so that early diagnosis with early treatment can have a positive effect on the further course of the disease. Self-healing cannot occur. A doctor should be consulted if the person affected suffers from sudden visual problems as a result of cavernous sinus thrombosis.

In most cases, these symptoms do not go away on their own and appear for no particular reason. Swollen and very red eyes also indicate cavernous sinus thrombosis and are usually accompanied by pain in the neck or in the head. Furthermore, cavernous sinus thrombosis can also lead to epileptic seizures, which should be treated directly by an emergency doctor or in a hospital. In some cases, sensory disturbances also indicate cavernous sinus thrombosis and must also be examined.

The diagnosis of this disease can be made by a cardiologist. However, further treatment depends on the exact severity of these symptoms. The life expectancy of the person affected may be limited by the cavernous sinus thrombosis.

Treatment & Therapy

If the cavernous sinus thrombosis is caused by bacterial inflammation, patients are given broad -spectrum antibiotics through a vein. If the pathogen is known or could be determined, a targeted antibiotic therapy is added to the broad spectrum therapy. In many cases, drug therapy with heparin is also used. This is usually administered in very high doses.

Other anticoagulants such as warfarin or phenprocoumon are also used. However, this therapy, like therapy with glucocorticoids, is quite controversial. Complete dissolution of the clot or surgical removal is rarely successful.

Prevention

Cavernous sinus thrombosis is very difficult to prevent. The thrombosis is often caused by an infection in the area of ​​the face or skull. Sinus infections in particular should therefore be taken seriously. If you suspect sinusitis, see a doctor.

If necessary, the doctor can initiate antibiotic therapy at an early stage. Since the “pill” is also a risk factor, women should carefully consider whether this is the right contraceptive method for them. Especially in combination with smoking, the risk of suffering a thrombosis increases significantly.

Aftercare

After the successful treatment of a cavernous sinus thrombosis, it is important to take certain follow-up measures in order to avoid the recurrence of a thrombosis and the development of secondary diseases (heart attack, stroke). The most important thing is to refrain from smoking and drinking alcohol, as both promote the development of thrombosis of any kind. In addition, existing high blood pressure should be treated with medication, since untreated high blood pressure also increases the risk of vascular diseases.

In addition, patients should strive for a change in diet and a generally healthy lifestyle that has a positive effect on the vessels. This should consist of regular exercise, avoiding processed foods and, in the case of overweight patients, weight loss. In addition, regular check-ups by a cardiologist and neurologist are required for aftercare of cavernous sinus thrombosis.

In addition to regular imaging of the heart and brain, the vessels (especially the cavernous sinus) should be examined for their permeability using ultrasound. If the blood is too thick, a diet low in vitamin K should also be aimed at to thin the blood. This consists of avoiding green vegetables (spinach, kale, green asparagus).

In addition, lifelong intake of blood-thinning medication (Macumar) may be necessary to reduce the likelihood of renewed thrombosis. In this case, the coagulation values ​​in the blood must be checked daily at home and regularly by the family doctor to prevent the blood from becoming too thin.

You can do that yourself

Since cavernous sinus thrombosis is a life-threatening situation, cooperation with a doctor should be sought at the first signs and health irregularities. Intensive medical care is required.

Basically, people with a tendency to develop thrombosis suffer from circulatory disorders. As part of self-help, various measures can therefore be used to help promote blood flow. Nutrition can be optimized so that blood production is stimulated. The consumption of legumes, nuts or pomegranates, for example, is helpful. These foods contain important elements that the body needs to optimize blood circulation and contribute to an increase in blood cell count.

In addition, physical activity can help improve health and general well-being. Daily exercise or playing a sport also stimulates the blood system. Postures in which the blood circulation is prevented from doing its job should be avoided. As soon as there are sensory disturbances or a tingling sensation on the skin, balancing movements to stimulate blood flow should be carried out.

If the person concerned suffers from epileptic seizures, care must be taken to avoid possible triggering stimuli. In addition, the person concerned should not put themselves in situations where they cannot get any help from others.

Cavernous Sinus Thrombosis