Sinus cavernosus thrombosis is a condition in which the sinus cavernosus is blocked by a blood clot or by a blood clot. It is a life-threatening condition.
What is sinus cavernosus thrombosis?
The term sinus cavernosus thrombosis refers to partial or complete occlusion of the cavernous sinus. The cavernous sinus is a venous blood vessel of the brain. It belongs to the sinus durae matris and is located on both sides of the turcic saddle (sella turcica). It receives 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:
- Oculomotor nerve
- Ophtalmic nerve
- Maxillary nerve
- Trochlear nerve.
Causes
Sinus cavernosus thrombosis usually develops on the basis of bacterial inflammation of the sinuses. Usually, the pathogens reach the cavernous sinus via the blood path from the frontal sinus (frontal sinusitis) or from the sphenoid sinus (sphenoidal sinusitis). However, bacterial inflammation of the soft tissues of the upper facial region can also spread to the cavernous sinus. Possible causative diseases here are boils or also erysipelas. Other causes include mastoiditis and meningitis. If the cause is bacterial, it is always referred to as septic sinus vein thrombosis. However, sinus cavernosus thrombosis can also be caused by diseases associated with increased blood clotting. These include, for example, polycythemia or antithrombin deficiency. Pregnant women have a higher risk of sinus vein thrombosis. Medications such as hormonal contraceptives or cortisone preparations also increase the risk.
Symptoms, complaints, and signs
Sinus cavernosus thrombosis tends to develop slowly. Early signs include a pressure pain in the corner of the nose and visual disturbances. Around the eyes, there may be signs of congestion in the eye. This affects the side where the thrombosis is located. 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 reduced extent. The affected person sees double images. The symptoms are accompanied by non-specific general symptoms such as nausea, vomiting, fever and chills. Later, the headaches increase. Neck pain may also occur. The pain radiates to the arms or radiates from one temple across the forehead to the other temple. Edema occurs around the eyelids and nasolabial folds. Epileptic seizures may occur. Psychotic symptoms or changes in temperament are also possible. In the full picture, the affected persons have very high fever. One speaks here also of septic temperatures. The eyes are clearly protruding, due to the disturbances of the eye mobility there is a threat of loss of vision. The conjunctiva may also be swollen (chemosis). Paralysis may occur as well as sensory disturbance and clouding of consciousness. In late stages, death may result from increased intracranial pressure. Leading symptoms of increased intracranial pressure are severe headache, vomiting, and a congestive papule. When these three symptoms occur together, it is also referred to as intracranial pressure triad. A complication is the sinus cavernosus syndrome. This clinical picture is characterized by the complete loss of the cranial nerves that run through the wall of the cavernous sinus. In addition, a sinus cavernosus fistula may develop. This results in a connection between the internal carotid artery or the external carotid artery and the cavernous sinus. This results in a flow reversal with venous outflow disturbances and an insufficient supply of oxygen-rich blood to the vessels of the brain. Sinus cavernosus thrombosis also poses the threat of small cerebral hemorrhages because blood outflow is disrupted and the thin walls of the sinus are severely stressed by the congested blood.
Diagnosis and course of the disease
Diagnosis of sinus cavernosus thrombosis is quite difficult. The signs of the disease are not definite and may be due to other conditions, such as an abscess or encephalitis. If thrombosis is suspected in this area, the D-dimer level in the blood can be determined.But even this can only confirm the suspicion, not confirm it. It is possible that a positive Griesinger’s sign may be observed. Because of the unclear symptoms, early cross-sectional imaging is recommended if sinus vein thrombosis is suspected. Computed tomography or magnetic resonance imaging can visualize infarcts or hemorrhages. With contrast medium, clots can also be well visualized. In exceptional cases, angiographies are also performed.
Complications
Sinus cavernosus thrombosis can result in severe complications and may even be fatal if treatment is inadequate or absent. Initially, the blood clot causes visual disturbances and paralysis of the eye muscles. This severely impairs vision and increases the risk of an accident. Epileptic seizures may also occur, which are also associated with an increased risk of injury. In addition, psychotic symptoms may occur in some cases, as well as changes in temperament. Furthermore, high fever and subsequently circulatory failure may occur. In the further course, there is acute danger to life due to the increased intracranial pressure. A typical complication is the sinus cavernosus syndrome, in which the cranial nerves and thus all neurological and mental functions fail. A sinus cavernosus fistula can also develop. In late stages, the impaired blood drainage causes small cerebral hemorrhages associated with serious complications. Drug therapy for sinus cavernosus thrombosis carries the risk of side effects and interactions. Because very high doses are usually administered, there is a risk of permanent kidney and liver damage. Some patients also develop an addiction or build up a tolerance to the agent in question.
When should you see a doctor?
Sinus cavernosus thrombosis must always be treated by a physician. In the worst case, this disease can cause the death of the affected person, so early diagnosis with early treatment can have a positive effect on the further course of the disease. An independent cure cannot occur. A doctor should be consulted if the affected person suffers from sudden visual complaints due to sinus cavernosus thrombosis. In most cases, these complaints do not disappear on their own and occur without any particular reason. Thereby, swollen and strongly reddened eyes also indicate sinus cavernosus thrombosis and are usually accompanied by pain in the neck or head. Furthermore, sinus cavernosus thrombosis may also cause epileptic seizures, which should be treated directly by an emergency physician or in a hospital. In some cases, disorders of sensibility also indicate sinus cavernosus thrombosis and must be examined as well. The diagnosis of this disease can be made by a cardiologist. However, further treatment depends on the exact manifestation of these symptoms. It is possible that the life expectancy of the affected person is limited by sinus cavernosus thrombosis.
Treatment and therapy
If sinus cavernosus thrombosis is caused by bacterial inflammation, patients receive broad-spectrum antibiotics through a vein. If the causative agent is known or could be determined, targeted antibiotic therapy is followed by broad-spectrum therapy. In many cases, drug therapy with heparin is also given. 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
Sinus cavernosus thrombosis is very difficult to prevent. Frequently, thrombosis is caused by an infection in the facial or cranial area. Sinusitis in particular should therefore be taken seriously. If sinusitis is suspected, a doctor should be consulted. If necessary, he or she 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 thrombosis increases significantly.
Aftercare
After successful treatment of sinus cavernosus thrombosis, it is important to take certain aftercare measures to prevent the reoccurrence of thrombosis, as well as the development of secondary diseases (heart attack, stroke). Most important is the renunciation of smoking, as well as alcohol consumption, since both promote the development of thromboses 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 disease. In addition, patients should strive for a change in diet and a fundamentally healthy lifestyle, which has a positive effect on the vessels. This should consist of regular exercise, avoidance of convenience foods and, in the case of overweight patients, weight reduction. In addition, for follow-up of sinus cavernosus thrombosis, regular check-ups with a cardiologist and neurologist must take place. In addition to regular imaging of the heart and brain, the vessels (especially the sinus cavernosus) should be examined by ultrasound to determine their permeability. If the blood is too thick, a low vitamin K diet should also be sought to thin the blood. This consists of avoiding green vegetables (spinach, kale, green asparagus). In addition, lifelong use of blood-thinning medications (Macumar) may be necessary to reduce the likelihood of recurrence of thrombosis. In this case, blood clotting levels must be checked daily at home, as well as regularly at the family doctor’s office, to prevent the blood from becoming too thin.
What you can do yourself
Because sinus cavernosus thrombosis is a life-threatening condition, cooperation with a physician should be sought at the first signs and health irregularities. Intensive medical care is necessary. Basically, people with a predisposition for thrombosis development suffer from circulatory disorders. Therefore, within the framework of self-help, various measures can be used that help to promote blood flow. The diet can be optimized so that the production of blood is stimulated. For example, the consumption of legumes, nuts or pomegranates is helpful. These foods contain important elements that the organism needs to optimize blood circulation and that contribute to an increase in blood cells. In addition, sports activities can help improve health and general well-being. Daily exercise or playing a sport also stimulates the blood system. Postures that prevent the blood circulation from working should be avoided. As soon as there are sensory disturbances or a tingling sensation on the skin, compensatory movements to stimulate blood flow should be performed. If the affected person suffers from epileptic seizures, care should be taken to avoid possible triggering stimuli. In addition, the affected person should not put himself in situations where he cannot get any help from others.
