- What triggers / Causes of Thrombosis of the cavernous sinus
- Pathogenesis (what is happening) at the time of Thrombosis of the cavernous sinus
- The symptoms of Thrombosis of the cavernous sinus
- Diagnosis of Thrombosis of the cavernous sinus
- Treatment of Thrombosis of the cavernous sinus
- Prevention of Thrombosis of the cavernous sinus
- Which doctors should be consulted if You have a Thrombosis of the cavernous sinus
What is Thrombosis of the cavernous sinus
What triggers / Causes of Thrombosis of the cavernous sinus:
The bowl occurs secondarily due changes in hemodynamics and blood properties, reactivity.
Pathogenesis (what is happening) at the time of Thrombosis of the cavernous sinus:
These possible ways of spread of infection in cerebral venous vessels.
Contact. When empyema of the sphenoid sinus and posterior ethmoid cells arises as a consequence of osteomyelitic process.
Hematogenous. Through numerous veins of the upper division of the nose and paranasal sinuses, the process spreads to the cavernous and less frequently on the upper sagittal sinus, becoming a continuation of the other phlebitis of the veins.
The formation of a blood clot in the cavernous sinus contribute to connective jumper in the lumen, which slow the movement of blood.
In cavernous sinus infection penetrates through the veins when the furuncle of the nose and purulent sinusitis - can be a complication of puncture of the maxillary sinus in the period of exacerbation of the process happens much less frequently in acute sinusitis.
The symptoms of Thrombosis of the cavernous sinus:
Secrete infectious, diversory and neurological syndromes with relevant clinical manifestations.
Local signs of the disease associated with the violation of the outflow of blood from the ophthalmic veins to cavernous sinus and include swelling and redness of the eyelid conjunctiva (chemosis), proptosis, limitation of eye movement and paralysis of the eye muscles, congestion of the optic nerve head, abruptly dilated veins and hemorrhage into the retina, decreased vision, paresis bordering the cavernous sinus discharge, trochlear, oculomotor and trigeminal nerves. Sometimes it is total bilateral ophthalmoplegia. Through the thin skin of the eyelids, forehead and root of the nose acts as an extended, tense, painful venous network.
Obsenations signs. Septic syndrome is largely caused by the absorption into the blood of metabolic products of microorganisms during infection and the proteolysis of blood clots in the background of hypercoagulability and reduced fibrinoliticheskoi activity.
The main complaint of patients - strong diffuse headache, often pressing, bursting, throbbing with frequent localization in the eye sockets.
As a consequence of septicopyemia repeated chills, intermittent fever (a sharp rise in body temperature and subsequent fall), profuse sweating (3-hour fluctuations of temperature in the range of 2-3 °C). There are signs of intracranial hypertension, the dissociation meningeal-tion phenomena.
The patient's condition is dire, due to sepsis, meningitis and local symptoms.
In acute sinusitis may develop thrombosis of the superior sagittal sinus with the veins of the head, swelling of the soft tissues of the nose, eyelids, forehead and crown, the development of tonic-clonic seizures in septic and meningeal phenomena, subperiosteal abscesses in the crown of the head.
Hemogram reflects an acute inflammatory response with a shift of neutrophils up to young cells, toxic granulation of leukocytes, anizocitozom, poikilocytosis - often tested positive for strep.
When rhinoscopy and x-rays revealed signs of lesions of the paranasal sinuses. The process can move to the other side.
There are meningeal symptoms were characteristic of their dissociation.
When lumbar puncture pus is found, but the cerebrospinal fluid can not be changed. When late diagnosis without treatment, a child can die within a few days.
Thrombophlebitis of the cavernous sinus milder, with no signs of septicopyemia, usually with unilateral lesions of the oculomotor nerve and has a more favorable prognosis.
Thrombosis of the cavernous sinus arise distant metastatic purulent lesions and primarily septic pneumonia, meningitis, metastatic purulent lesions in the cranial cavity, kidney, liver, lung, skin heads, in the retropharyngeal space, in the ear. Septic emboli are distributed via the internal jugular, Vena cava veins, the right half of the heart and the capillaries of the pulmonary circulation.
The severity of symptoms is different and is related to the severity of the injury, from the effects of phlebitis with preservation of the lumen of the vessel for blood flow to the sinus thrombosis with purulent fusion of its walls.
Complications. If your child suffered a thrombosis of the cavernous sinus, in the long-term he is still pronounced residual effects - decreased vision, paresis of the lateral rectus muscles of the eyeball, paralysis of the abductor nerve, ptosis, anisocoria, starobazarny arachnoiditis, which never happens with thrombophlebitis of the cavernous sinus.
Forecast rhinogenic intracranial complications depends on the timing of their recognition and treatment at the stages preceding the terminal. Thrombosis of the cavernous sinus was previously considered a disease with fatal outcome. Currently, the mortality reaches 20.
Diagnosis of Thrombosis of the cavernous sinus:
The difficulty in diagnosis of the source of intracranial complications often due to the fact that sinusitis in children often occur hidden, asymptomatic. Anoscopically picture is erased, it is not always possible to detect characteristic changes as edematous mucosa closes the exit orifice of the paranasal sinuses and stops the outflow of secretion in the nasal cavity, whereby the contents of the sinus is absorbed into the blood and the conditions for the distribution process in the cranial cavity.
The most difficult the definition of a primary source of intracranial complications in lesions of the sphenoid sinus, when it is difficult differential diagnosis, determination of the nature and localization process.
An increased frequency of diagnostic errors in neonates and infants due to latent uti sinusitis and effaced common clinical, neurological and anoscopically signs.
The diagnosis of thrombosis of the cavernous sinus is placed on the basis of clinical data and primarily in patients with severe septic condition, the symptoms of meningitis and the syndrome of the cranial nerves.
Important in the diagnosis of cerebral symptoms, a thorough neurological data, otoneurological, ophthalmic, x-ray examination with detection of organic neurological symptoms of Central nervous system lesions, congestion in the fundus, analysis of cerebrospinal fluid along with a detailed study of the history, clinical presentation and physical examination of ENT-organs, anoscopically data with the mandatory study of all of the paranasal sinuses, including the sphenoid sinus in critically ill.
Of great practical importance are the electroencephalography data (the identification of focal or generalized slow pathological waves), carotid angiography (offset vascular brain abscesses), echoencephalography, pneumoencephalography, ventriculography (identification of indirect signs of brain damage).
Computer, magnetic resonance and radionuclide gamma-ray tomography to diagnose EPI - and subdural abscesses as close to the modified sinus (in most cases, frontal), and at a considerable distance from her.
These studies clearly structured brain, its ventricles, subarachnoid cracks, can accurately determine the nature of the process (abscess of the brain, focal or generalized arachnoideum, perifocal brain edema). You can get a clear visual information about the size of an abscess of the brain, the thickness of the capsule, its relation to cerebrospinal fluid pathways and functionally important brain structures.
Precise determination of the thickness of the capsule of the abscess is of great importance not only for diagnosis but also for the choice of tactics of surgical intervention. It is possible to identify single-chamber, multi-chamber and multiple abscesses of the brain, hematogenous brain abscess, located far from the paranasal sinus in the occipital, parietal, temporal lobes.
When detection and treatment in children rhinogenic intracranial complications should be a systematic observation of the otorhinolaryngologist, neurologist, ophthalmologist and pediatrician.
Differential diagnosis. Thrombosis of the cavernous sinus is differentiated with focal meningoencephalitis, on the computer tomogram is determined by the low-density area without clear boundaries, with a slight perifocal edema.
ru/" target="_blank">Treatment of Thrombosis of the cavernous sinus:
Children with rhinogenic intracranial complications conduct a comprehensive intensive therapy. Urgent surgical intervention is carried out for wide opening of all lesions.
Indications for surgery absolute.
When the operation on the frontal sinus shows a fairly extensive exposure of the Dura mater of the anterior cranial fossa to the border with healthy tissue.
When epidural abscess consistently and carefully open and remove all of the diseased tissue, abscess widely opened, washed with antibiotic solution and create favorable conditions for wound drainage.
When subdural abscess rhinogenic origin reveal a characteristic local changes of the Dura mater: thinning, yellowish color and bulging, no pulsation, granulation, fibrous plaque, swishy, in a direction which is opened, and then washed or drained the abscess cavity.
In the absence of subdural fistula abscess diagnosed by puncture through the Dura in 3-4 directions to a depth of 4 cm.
Exposure of the meninges and drainage of rhinogenous produce abscesses after external opening of frontal sinus in older children.
When well formed thick capsule, the small depth and size of the abscess is removed entirely, together with the capsule. In children, the destruction of the abscissa is difficult due to the very thin capsule, its cohesion with the Dura and the bone structures.
If the abscess capsule slim, cerebral abscess is large and located deep in the brain, using the puncture method of treatment. Approach to the abscess possible through the outer skin of the head and directly from the primary purulent focus in the paranasal sinuses.
Thrombosis of the superior sagittal sinus of his expose, reveal and remove the clot. To stop bleeding the tampon is introduced between the sine n bone.
Thrombosis of the cavernous sinus surgical approach is impossible because of the topography and surgical intervention is limited to a broad opening of the affected sinus, elimination and reliable drainage of the primary pathological focus.
Carry out massive antibacterial therapy with the introduction of optimal doses of broad-spectrum antibiotics, in severe rhinogenic meningitis appoint endolumbalnoe (sometimes suboccipital) the introduction of antibiotics or solution of metronidazole.
Conduct detoxication therapy (intravenous plasma, gemodeza, reopoliglyukina) using the latest methods of extracorporal detoxication (plasmapheresis, irradiation with ultraviolet rays autologous blood, hemosorption blood, hyperbaric oxygen therapy).
Dehydration is carried out by intramuscular injection of magnesium sulphate, intravenous infusion of 40 glucose solution, the appointment of diuretics.
Spend giposensibiliziruyuschey and restorative treatment, immunotherapy (antistaphylococcal plasma, gamma globulin, serum polyglobulia, staphylococcal toxoid).
In complex therapy of thrombosis of the cavernous and superior sagittal sinuses necessarily include direct anticoagulants (heparin) and indirect (bishydroxycoumarin, nitrofuran, sinkumar, fenilin) actions to disrupt the biosynthesis of prothrombin and other coagulation factors under constant supervision of thromboelastogram.
Treatment anticoagulants ceased gradually increasing the interval between doses, since rapid removal may cause compensatory sharp increase in the concentration of prothrombin with the risk of thrombosis.
In severe cases use endovascular (vnutrikvartalny) regional infusion therapy using endogenous activators of fibrinolysis in combination with antibiotics, which accelerates the recanalization of sinuses.
At the same time using blockers of proteolytic enzymes secreted by the staph (contrycal, the drug). Lesser effect of Epsilon-aminocaproic acid. The creation of a permanent high concentrations of thrombolytic and antimicrobial drugs in the vascular pool pathological focus promotes rapid thrombolysis to restore blood flow in the cavernous sinus, relief of the inflammatory process.
Prevention of Thrombosis of the cavernous sinus:
Of primary importance are early hospitalization and prompt treatment of children with the first threatening symptoms purulent complications of sinusitis, especially with periostitis of its walls, starting with orbital complications, symptoms of intracranial hypertension, and most importantly - improve their diagnosis and treatment.