Thrombosis of the cerebral venous sinuses is quite rare, but it can have serious consequences, such as, for example, a venous stroke. What causes cerebral venous sinus thrombosis? What symptoms may indicate it? What is the treatment?

Cerebral venous sinus thrombosiscan lead to a venous stroke, because although strokes are typically caused by blockage of blood flow in the arteries, diseases in this group may also result from impaired vascular function venous. The venous sinuses of the brain are venous spaces to which blood is transported from the deeper veins of the brain. Blood flows from the sinus system to the jugular vein, and from there it is transported to the heart. Under normal conditions, blood flows freely through the sinuses. One condition that can interfere with normal blood transport is sinus thrombosis in the brain. In the case of this disease, the blood supply to the structures of the nervous system is impaired, i.e. a stroke - in such a situation referred to as a venous stroke. Of all strokes, those caused by venous thrombosis account for less than 1%. The individual can occur at any age, it is slightly more common in women.

Cerebral venous sinus thrombosis: causes

In any blood vessel, thrombosis is triggered by three factors that are collectively known as the Virchow triad. They are:

  • blood flow disorders
  • damage to the vessel wall
  • increase in blood clotting

Cerebral venous sinus thrombosis is most often caused by an increased tendency for blood to clot. This can occur for many different reasons, including:

  • infections (both local infections, such as meningitis, otitis and sinusitis or abscesses in the head area, but also systemic infections: tuberculosis, HIV, sepsis or endocarditis)
  • coagulation disorders associated with hypercoagulability (such as the carrier of factor V Leiden mutations, deficiencies of proteins with anticoagulant activity - antithrombin III, proteins C and S, and the presence of antiphospholipid antibodies in the serum or hyperhomocysteinemia)
  • ailmentshematological (e.g. polycythemia, sickle cell anemia, disorders related to the number of platelets - both their deficiency and excess),
  • pregnancy and puerperium
  • cancer
  • conditions after surgical treatment (this especially applies to procedures performed on the head and neck)
  • dehydration
  • heart failure (especially in such stages, in which there is a significant stagnation of blood in the organs)
  • use of certain medications (e.g. cisplatin, hormonal contraceptives, heparin or glucocorticosteroids)
  • nephrotic syndrome
  • chronic diseases, especially those of an inflammatory nature (e.g. sarcoidosis, systemic lupus erythematosus or Crohn's disease)

The appearance of a blood clot in the lumen of the venous sinus impairs the proper blood flow - the degree of disturbances and the associated symptoms depend on the specific venous sinus involved and the size of the thrombus.

Cerebral venous sinus thrombosis: symptoms

The most common (occurring in up to 90 percent of patients) symptom of venous sinus thrombosis is headache. It has a different character: in some patients it is extremely intense (which may suggest the occurrence of subarachnoid bleeding), in other patients the symptoms are initially minor and gradually increase in intensity over time. . Symptoms of this condition, which are also relatively common in patients with thrombosis of the venous sinuses of the brain, are:

  • vomiting
  • visual disturbance (related to optic disc edema)
  • palsy of cranial nerves

Other symptoms that may occur in the course of venous sinus thrombosis are:

  • episodes of seizures (usually one half of the body, but rarely generalized seizures)
  • bulging eyeballs
  • disturbance of consciousness
  • fever
  • disturbance of consciousness

Cerebral venous sinus thrombosis: recognition

Due to its incidence, the suspicion of venous sinus thrombosis is quite rare. Symptoms occurring in the course of the disease may indicate the need for imaging diagnostics and it is in such examinations that it is possible to visualize the thrombus in the lumen of the venous sinuses, or the consequences of their presence (e.g. disturbances in the blood supply to the brain tissues). Usually, in order to find the cause of the symptoms present in the patient, it is performedComputed tomography (CT) of the head or magnetic resonance imaging (MR), both are performed with or without contrast. Also used in the diagnosis of venous sinus thrombosis are tests that allow to visualize blood vessels, such as angio-KT or angio-MR.

Cerebral venous sinus thrombosis: treatment

Treatment of cerebral venous sinus thrombosis is based on the use of anticoagulants. In the initial period of therapy, heparins are used: low molecular weight (administered subcutaneously) or unfractionated (administered intravenously). After stabilization of the patient's condition, heparin preparations are replaced with oral anticoagulants (e.g. warfarin or acenocoumarol). Treatment with oral anticoagulants is recommended for a different duration - in patients with transient thrombosis risk factors, three months of therapy may be sufficient. On the other hand, in patients whose risk factors are not modifiable (e.g. due to the presence of a chronic inflammatory disease), it may be necessary to use medications that reduce blood clotting even for the rest of their lives. Pharmacological therapy is the mainstay of treatment of venous sinus thrombosis in the brain. In some patients (e.g. those with a large clot), thrombolysis (the use of substances that dissolve the clot) may be useful. intracranial. For this purpose, glucocorticosteroids, anti-inflammatory drugs and antiemetics are used. In a situation of exceptional intensification of intracranial hypertension, which is life-threatening, a craniectomy (i.e. opening the skull to reduce the pressure in it) may be performed.

Cerebral venous sinus thrombosis: prognosis

In the course of venous stroke, the prognosis of patients is better than in the case of arterial forms of these diseases. The rate of ultimately fatal cerebral sinus thrombosis is approximately 10-15 percent. Permanent complications (in the form of epileptic seizures or focal neurological deficits - e.g. paralysis and paresis) among treated patients are observed in up to about 20 percent of them. formation of blood clots - prophylactic anticoagulation treatment is necessary.

Category:

Cardiology