Cerebral Veins and Sinuses
Occlusion of cerebral veins and sinuses associated with various disorders (Table 47.1). Lateral, cavernous, superior sagittal sinuses most frequently affected.
Lateral Sinus Thrombosis
Usually due to otitis media, mastoiditis. Infants, children most commonly affected. Septicemia in 50%.
Symptoms and Signs
Fever, headache, nausea, vomiting (increased intracranial pressure). Papilledema (usually bilateral) in 50%. Additionally: drowsiness, coma, seizures, cranial nerve signs; systemic signs of septicemia.
Gradenigo syndrome: lateral rectus weakness (sixth nerve palsy), facial pain (fifth nerve damage).
Investigations
Blood: leukocytosis; cultures positive in 50%. CSF: increased pressure, turbid appearance, leukocytosis.
CT, MRI: clot may appear as linear density (“cord sign”). Magnetic resonance venography (MRV): focal narrowing or nonvisualization of involved portion of sinus.
Treatment
Antibiotics for underlying otitis media; surgical drainage; jugular vein ligation. Nonseptic patients: thrombolytic therapy may suffice.
Table 47.1 Disorders Associated with Cerebral Vein and Sinus Occlusion | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
