Thrombophlebitis and thrombosis of cerebral veins: causes, symptoms, diagnosis, treatment

Pathological conditions of the nasal cavity (inflammation, tumors, traumatic injuries) almost without exception affect its venous system, which communicates with the venous system of the brain via anastomoses. These anastomoses often serve as pathways for the introduction of pathological elements from foci of infection in the nasal cavity (microorganisms, purulent emboli, tumor cells, etc.), which determine the nature and forms of the resulting lesions of the venous system of the brain. The main conductor of infection from the nasal cavity to the venous system of the brain are rhino-ophthalmocerebral anastomoses, through which the infection first enters the cerebral veins, then the venous sinuses of the brain and the veins of the meninges.

The veins of the brain are divided into superficial and deep. The superficial veins run radially in the brain matter towards the convexital surface of the brain, forming a venous pial network, from which larger veins are formed, flowing into the venous sinuses formed by the dura mater.

Deep veins collect blood from the walls of the ventricles, subcortical ganglia, nuclei and vascular plexuses and merge into the great vein of the brain, which flows into the straight sinus. All cerebral venous sinuses communicate with each other, which occasionally leads to massive thrombosis in particularly virulent infections. Blood flows out of the cranial cavity through the sinus confluence system mainly through the two jugular veins - right and left. Numerous anastomoses connect the cerebral sinuses with the veins of the face and the veins of the diploë, lying between the vitreous plate and the coivsital layer of dense bone, and the system of graduates - with the veins of the soft tissues of the skull. These circular venous collectors can serve as a direct route for infection penetration to the intracerebral venous systems from purulent foci in the face, nose, paranasal sinuses and head surface, as well as a reverse route for infection penetration from the cerebral sinuses through emissaries into the soft tissues of the convexital surface of the head and face. Thrombosis of the cerebral veins can occur with purulent-inflammatory diseases of distant organs.

Thrombophlebitis of the veins of the brain occurs in individuals 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 subfebrile temperature with periodic increases in body temperature to 38-39 ° C, typical of septic fever, headache, worsening in the lying position, tinnitus, dizziness, nausea, sometimes vomiting, transient swelling under the eyes, apathy, stupor, sometimes a soporous state. Focal symptoms include seizures, hemi- and monoparesis. In the fundus - congestive edema and varicose veins. The pressure of the cerebrospinal fluid is increased, slight cytosis is determined in it, sometimes a small number of erythrocytes, the amount of protein is moderately increased.

Diagnosis of cerebral vein thrombophlebitis is very difficult, especially in the presence of purulent processes in the paranasal sinuses and, to a lesser extent, in the middle ear, since in the latter case septic thrombophlebitis of the sinuses, in particular the sigmoid, is more often observed. Suspicion of the presence of cerebral vein thrombosis should arise in the presence of concomitant thrombophlebitis of the extremities, acute inflammatory processes in the internal organs, and general infection.

Cerebral vein thrombosis is accompanied by a picture of venous congestion, which can be established by Doppler examination of the brain. With cerebral vein thrombosis, a syndrome of "flickering" and migrating cortical focal symptoms occurs, which is not typical for thrombophlebitis of one cerebral venous system. A distinction is made between thromboses of the superficial and deep veins of the brain.

Thrombosis of the 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 flow into the superior sagittal sinus. The overwhelming majority of cases of thrombosis of the superficial veins are observed in the postpartum period, however, there are frequent cases when this disease occurs with purulent processes in the paranasal sinuses and on the face.

The clinical picture is characterized by general clinical signs of an infectious disease and certain neurological symptoms. The disease begins with headache and fever, then the pain intensifies, nausea and vomiting appear. In the blood - a typical picture of a purulent-inflammatory process, in the cerebrospinal fluid - elements of an inflammatory reaction. General cerebral symptoms are manifested by impaired 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 migrating, which is explained by the transient mosaic nature of the process, moving from one group of veins to another. The morphological substrate that causes the occurrence of the above symptoms are hemorrhagic infarctions in the gray and white matter of the brain, intracerebral and subarachnoid hemorrhages, ischemia and cerebral edema as a result of venous congestion. Blood may be detected in the cerebrospinal fluid during a lumbar puncture.

Deep vein thrombosis of the brain. The deep, or internal, veins of the brain are composed of the villous and thalamostriate veins, which collect blood from the basal ganglia of the cerebrum, the transparent septum, the plexuses of the lateral ventricles and flow into the great vein of the brain. The great vein of the brain receives blood from the sphenoid vein and the veins of the cerebellum - inferior, superior and anterior, flows into the straight sinus.

The clinical picture is characterized by a particularly severe course. The symptoms correspond to the signs of damage to those structures of the brain from which blood is collected in this vein. Patients usually quickly fall into a comatose state, general cerebral phenomena are sharply expressed, signs of damage to the stem and subcortical structures dominate. Lifetime diagnostics are extremely difficult, since the clinical picture has much in common with hemorrhagic stem stroke.

The diagnosis is based on the consideration of concomitant foci of infection - thrombophlebitis of all extremities, inflammatory foci in areas rich in venous plexuses, such as in the abdominal cavity or small pelvis (after an abortion or in the postpartum period), as well as inflammatory processes in the paranasal sinuses, on the face, in the auricular area, which have a well-developed network of anastomoses with the venous system of the brain. Differential diagnostics are carried out in relation to hemorrhagic or ischemic stroke, purulent meningitis, brain abscess, rupture of cysticercus into the ventricles of the brain, etc.