Table of Contents
What are the main causes of sigmoid sinus thrombosis?
The sigmoid sinus is also one of the cerebral venous sinuses, which directly receives the venous blood flowing through the transverse sinus, and indirectly connects with the medial and lateral cerebral veins, the medial and lateral hemispheric veins, and the basal cerebral veins. The main cause of sigmoid sinus thrombosis is bacterial infection, while the primary focus of inflammation is mostly mastoiditis (high bone in the back of the ear) and otitis media. After mastoiditis and otitis media appear clinically, due to improper treatment, sudden systemic infection, increased intracranial pressure and facial stroke should be considered as this disease.
What are the symptoms of sigmoid sinus thrombosis?
When the sigmoid sinus thrombosis occurs, the following symptoms can occur:
- Edema, pain, and venous distension (commonly known as tendon exposure) in the mastoid process (high bone raised behind the ear).
- Manifestations of systemic bacterial infection, such as chills and fever, and increased white blood cells were found in ear blood.
- Increased intracranial pressure. The symptoms are severe headache and vomiting. Examination of the fundus with funduscopy can reveal papilledema of the optic nerve.
- Facial apoplexy occurs. The affected eye can’t squint outward, one side of the face is numb, and some have muscle paralysis around the eyes. When the thrombosis extends to the jugular vein, it can paralyze the glossopharyngeal nerve, accessory nerve and vagus nerve, and cause soft palate ptosis on the diseased side, uvula deviation to the healthy side, pharyngeal reflex disappearance, dysphagia, hoarseness and dysarthria.
- lumbar puncture for cerebrospinal fluid can find that the pressure of cerebral blood vessels increases, and there are red and white blood cells in cerebrospinal fluid.
There are three main methods to treat sigmoid sinus thrombosis:
- apply antibiotics in large quantities. We should pay attention to the targeted and rational use of antibiotics, which is not only effective for bacterial infection of sigmoid sinus and related veins, but also has a positive therapeutic effect on primary focus otitis media and mastoiditis.
- Application of dehydrating agent. Mannitol intravenous infusion is generally used for intracranial hypertension.
- hormone therapy. Hydrocortisone or dexamethasone can be used.
A study from University Hospital of Zurich aimed to investigate the clinical characteristics, imaging features, and outcomes of patients diagnosed with sigmoid sinus thrombosis. The researchers reviewed medical records of patients treated at the University Hospital of Zurich between 2010 and 2020. They focused on the presenting symptoms, diagnostic imaging modalities used (such as MRI and CT scans), the presence of associated risk factors (e.g., infections, trauma, or hypercoagulable states), and the management strategies employed (including anticoagulation therapy and surgical interventions).
The study identified a total of 30 patients with sigmoid sinus thrombosis during the specified period. The most common presenting symptoms were headache (80%) and hearing loss (60%). Imaging confirmed the presence of thrombosis in the sigmoid sinus in all cases, with associated findings such as venous infarction in the adjacent brain tissue in some patients. The majority of patients (70%) had identifiable risk factors, with infections being the most prevalent. Management primarily involved anticoagulation therapy, which was effective in resolving symptoms and preventing complications in most cases. The study also highlighted the importance of early diagnosis and timely intervention to improve patient outcomes.
This research contributes to the understanding of sigmoid sinus thrombosis by providing a detailed analysis of its clinical presentation, diagnostic challenges, and effective management strategies in a European tertiary care setting.
