Thrombotic sigmoid sinusitis occurs most often as a complication of ENT diseases. ZZZE is mentioned as otitis media (chronic, cholesteatoma or acute). What are the symptoms of cavernous sinus thrombosis and why is IBS so dangerous? How is his treatment going?
Thrombotic sigmoid sinusitis(Latinthrombophlebitis sinus sigmoidei , sometimes abbreviated as ZZZE) is now a rare and lucky disease because this disease is extremely dangerous. The exact incidence of thrombotic sigmoid sinusitis is unknown, but it is known that it can occur in a patient of all ages, whether in a few years old or in an elderly person. This possibility is mainly due to the causes of thrombotic sigmoid sinusitis.
Thrombotic sigmoid sinusitis: causes
Thrombotic sigmoid sinus is typically a complication of other medical conditions. It is included in several different so-called intracranial complications that may arise as a result of various ear diseases. The main cause of IBD is chronic otitis media with cholesteatoma, but another source of this problem may be acute otitis media. The sigmoid sinus belongs to the group of intracranial structures in which venous blood is collected. In fact, the sigmoid sinus is a specific protrusion of the dura mater of the brain - the mention of it is important because such a structure of the sigmoid sinus is associated with the developing symptoms of sigmoid sinus thrombosis. The structures of the sigmoid sinus are quite delicate, and are also adjacent to the mastoid elements. In the case of ear diseases, this location of the sigmoid sinus is rather unfavorable - the inflammatory process in the ear may spread to the venous sinus through the air structures of the mastoid process. There is also another possibility of developing IBS - inflammation may first begin in small venous vessels near the sigmoid sinus, and then spread to it, leading to the onset of this dangerous disease.the sigmoid sinus initially slows down blood flow through this structure, and then a thrombus appears in the sinus lumen. As the disease progresses, the size of the thrombus increases - it may extend to the next sinuses, but even much further, because of the lumen of the internal jugular vein. Initially, the thrombus is sterile, but over time it usually becomes infected with bacteria - this condition is very dangerous, as it may spread bacteria into the bloodstream and cause sepsis.
Thrombotic sigmoid sinus: symptoms
The first symptoms of IBD are very uncharacteristic. Patients may complain of worse well-being, weakness or slight headache and a slight increase in body temperature. Later - as the thrombus grows and the bacteria spread in the blood - the complaints of patients become more pronounced. When the disease is fully developed, symptoms of sigmoid sinus thrombosis may be:
- meningeal symptoms (e.g. neck stiffness)
- characteristic fever (referred to as wave fever, associated with sudden changes in body temperature during the day - in the morning the patient may have a completely normal temperature, while in the evening he may struggle with a fever exceeding 40 degrees Celsius)
- violent chills
- severe pain in the affected ear
- nausea and vomiting
- significant increase in breathing and heart rate
Thrombotic sigmoid sinus: diagnosis
Many different studies play a role in the diagnosis of thrombotic sigmoid sinusitis. Patients undergo a thorough physical examination, including otoscopy. In the examination of the ear it is possible to detect, inter alia, purulent discharge. The physician may also determine the presence of characteristic symptoms in patients, such as the Voss symptom (no murmur during auscultation of the internal jugular vein due to the presence of a blood clot in this vessel) or Griesinger's symptom (soreness and swelling of the posterior part of the mastoid process). Laboratory tests (such as blood culture, performed to diagnose possible sepsis), as well as imaging tests (e.g. computed tomography of the head, allowing to determine the degree of disorders existing in patients) are also important in the diagnosis of IBS.
Thrombotic sigmoid sinus: treatment
Surgical treatment plays a major role in the treatment of thrombotic sigmoid sinusitis. The purpose of such procedures is resection of infected ear tissues, e.g. it may be necessary to perform a surgeryanthromastoidectomy (removal of mastoid tissue). In patients with IBS, the sigmoid sinus is also punctured - if a thrombus is found in it, doctors remove it from the sinus structures.
Pharmacological treatment is also used in the treatment of IBS. Patients are primarily given antibiotics - usually, due to the severity of sigmoid sinus thrombosis, patients are treated with more than one antimicrobial agent. Due to the course of HRM therapy, patients with this unit absolutely require hospitalization.
Thrombotic sigmoid sinus: prognosis
The prognosis of patients with sigmoid sinus thrombosis is not favorable - death may occur in up to 1 in 5 patients. Such a high mortality in the course of ZZZE is associated with, for example, possible complications of this disease, which include the formation of secondary abscesses in various organs (e.g. in the lungs or brain) or the previously mentioned sepsis.
About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.