Thrombophlebitis and cerebral vein thrombosis: causes, symptoms, diagnosis, treatment

Pathological conditions of the nasal cavity (inflammation, tumors, traumatic injuries) virtually without exception affect her venous system, which is reported through anastomoses with the venous system of the brain. These anastomoses often serve as ways of bringing into the last pathological elements from the foci of infection of the nasal cavity (microorganisms, purulent emboli, tumor cells, etc.), which determine the nature and forms of the lesions of the venous system of the brain. The main conductor of the infection from the nasal cavity to the venous system of the brain are the rinoopthalmo-cerebral anastomoses, through which the infection first enters the cerebral veins, then into the venous sinuses of the brain and into the veins of the meninges.

The veins of the brain are divided into superficial and deep. The superficial veins go in the brain material radially in the direction of the convectional surface of the brain, forming a venous pial network from which larger veins are formed that flow into the venous sinuses formed by the dura mater.

Deep veins collect blood from the walls of the ventricles, subcortical nerve ganglia, nuclei and vascular plexuses and merge into a large vein of the brain, flowing into a straight sinus. All cerebral venous sinuses communicate with each other, which occasionally leads to massive thrombosis with a particularly virulent infection. Blood through the system of fusion of sinuses flows from the cavity of the skull mainly along two jugular veins - right and left. Numerous anastomoses connect the brain sinuses with facial veins and diplo veins, lying between the vitreous plate and the co-axial layer of dense bone, and the graduates system with the veins of the soft tissues of the skull. These circular venous collectors can serve as a direct route for penetrating the infection to the intracerebral venous systems from purulent foci in the face, nose, paranasal sinuses and the head surface, and vice versa by penetrating the infection from the brain sinuses through emissaries into the soft tissues of the convective surface of the head and face. Thrombosis of cerebral veins can occur with purulent-inflammatory diseases of distant organs.

Thrombophlebitis of the veins of the brain occurs in persons suffering from phlebitis of the veins of the extremities and pelvic organs, with purulent processes in the small pelvis and extremities, with purulent meningitis. The clinical picture is characterized by a subfebrile condition with periodic body temperature rises of up to 38-39 ° C, characteristic of septic fever, a headache worse in the supine position, head noise, dizziness, nausea, sometimes vomiting, temporary swelling under the eyes, apathy, comparative state. From focal symptoms, convulsive seizures, hemi and monoparesis are observed. On the fundus there is congestive edema and veins. The pressure of the cerebrospinal fluid is increased, it determines a small cytosis, sometimes a small amount of red blood cells, a moderately increased amount of protein.

Diagnosis of cerebral venous thrombophlebitis presents great difficulties, especially in the presence of purulent processes in the paranasal sinuses and to a lesser degree in the middle ear, since in the latter case septic thrombophlebitis of the sinuses, in particular sigmoid, are more often observed. Suspicion of the presence of thrombosis of the cerebral veins should occur with concomitant thrombophlebitis of the extremities, acute inflammatory processes in internal organs, general infection.

Thrombosis of the veins of the brain is accompanied by a picture of venous stasis, which can be established with a doplerogram study of the brain. With thrombosis of the veins of the brain there is a syndrome of "flickering" and migrating cortical focal symptoms, which is not typical for thrombophlebitis of a single cerebral venous siius. There are thromboses of the superficial and deep veins of the brain.

Thrombosis of superficial veins of the brain. The superficial veins of the brain collect blood from the convolutions of the dorsal-lateral, medial surfaces of the cerebral hemispheres and merge into the upper sagittal sinus. The overwhelming majority of cases of venous thrombosis are observed in the postpartum period, but cases when this disease occurs in purulent processes in the paranasal sinuses and on the face are not uncommon.

The clinical picture is characterized by general clinical signs of an infectious disease and certain neurological symptoms. The disease begins with the onset of a headache and an increase in body temperature, then the pain intensifies, nausea and vomiting appear. In the blood - a typical picture of a purulent-inflammatory process, in the spinal cord fluid - elements of an inflammatory reaction. General cerebral symptoms are manifested in a disorder of consciousness, sometimes with psychomotor reactions. Focal symptoms are manifested by paresis or paralysis of the limbs, aphasia, focal or general epileptic seizures, etc. As a rule, these symptoms are "flickering" and migratory in nature, which is explained by the transient mosaic process that passes from one group of veins to another. The morphological substrate that causes these symptoms is hemorrhagic infarctions in the gray and white matter of the brain, intracerebral and subarachnoid hemorrhages, ischemia and cerebral edema as a result of emerging venous stasis. With lumbar puncture, blood can be detected in the cerebrospinal fluid.

Thrombosis of the deep veins of the brain. Deep, or internal, veins of the brain are composed of villous and thalamostrian veins, which collect blood from the basal ganglia of the brain, transparent septum, plexus of the lateral ventricles and flow into the large vein of the brain. A large vein of the brain takes blood from the sphenoid vein and the veins of the cerebellum - the lower, upper and anterior, merges into a straight sine.

The clinical picture is characterized by a particularly severe course. The symptomatology corresponds to the signs of the lesion of those structures of the brain from which blood is collected into this vein. Patients usually quickly fall into a coma, sharply expressed cerebral events, dominated by signs of damage to stem and subcortical structures. Intravital diagnosis is extremely difficult, because the clinical picture has much in common with hemorrhagic stroke.

The diagnosis is based on taking into account the concomitant foci of infection - thrombophlebitis limbs, inflammatory foci in areas rich in venous plexuses, for example in the abdominal cavity or pelvis (after abortion or in the postpartum period), as well as inflammatory processes in the paranasal sinuses, on the face, in the auricular a region with a well-developed network of anastomoses with the venous system of the brain. Differential diagnosis is carried out with regard to hemorrhagic or ischemic stroke, purulent meningitis, cerebral abscess, breakthrough of cysticerci into the ventricles of the brain, etc.