The clinical manifestations of cerebral venous sinus thrombosis will depend on the sinus(es) that are involved.
To understand what a cerebral venous sinus thrombosis as happened to Estudiantes de La Plata player Javier Altamirano, We must first understand what these structures are. He brain It is covered by three membranes that separate it from the skull bone, called meninges. The thickest meninge is the outermost one (the one in contact with the skull), called the dura mater, which in turn is made up of two layers. In some places these two layers of dura mater separate and venous sinuses form between them. Blood reaches the brain through the arteries and returns to the heart through the veins, after the brain has consumed its oxygen and nutrients and disposed of its waste. The venous sinuses have the function of receiving venous blood from the brain and cerebellum and carrying it towards its exit from the skull through the internal jugular veins, where it will continue its path to the heart again. They form a network where blood passes from one to another, some being of greater relevance due to their size and location.
A thrombosis Venous sinus is the occlusion by a clot of one or more of these structures. This means that blood cannot circulate there, generating an increase in venous pressure backwards and potentially producing a venous cerebral infarction (that is, a permanent injury to a part of the brain). brain due to poor blood flow), an intracerebral hematoma, and brain edema or swelling. This can trigger an increase in pressure within the cranial cavity (it must be taken into account that the skull is a rigid structure that cannot extend due to an increase in its contents, as occurs in cerebral edema or with the presence of a hematoma. ), called intracranial hypertension.
There are different causes of these thrombosis, for example: infections (such as meningitis, otitis, sinusitis, abscesses), tumors, thrombophilias and diseases that promote excessive coagulation such as antiphospholipid syndrome, head trauma, consumption of some drugs such as oral contraceptives, dehydration and arteritis, among other.
The clinical manifestations of a cerebral venous sinus thrombosis They will depend both on the sinus or sinuses that are compromised and on the existence of significant collateral circulation, that is, an alternative route that allows blood to drain from the brain in the absence of flow through said sinus.
In some cases, the location of the occlusion is also important, such as in the superior longitudinal sinus. This sinus runs along the top of the brain and in the middle, it forms in front at the level of the forehead and runs backwards until it divides at the nape of the neck into two transverse sinuses (one on each side), which then end in the internal jugular veins. . Therefore, if the superior longitudinal sinus is blocked in the front third, it does not carry the same severity as if it occurs in its posterior third, where it must have already received a large part of the venous blood from both cerebral hemispheres.
Among possible clinical manifestations of cerebral vein thrombosis We can name, for example: headache, seizures, deterioration in the state of consciousness, neurological deficit (such as weakness in movement, a sensory deficit or an alteration in the understanding and/or expression of language).
The diagnosis of cerebral venous sinus thrombosis is made through imaging studies such as MRI or digital angiography. Treatment consists of anticoagulation with heparin and evaluating and resolving the underlying causes to avoid a new thrombotic event.
Dr Damian Bendersky (MN 130405). Neurosurgeon (Instagram: @consultoriodedolor, website: www.consultoriodedolor.com.ar)
Source: Ambito
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