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Sinus Thrombosis

sinuses, petrous, cerebral, diseases, disease, transverse and veins

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. SINUS THROMBOSIS Thrombosis of the cerebral sinuses may occur as the result of grave debilitating diseases ("marantic" or "primary" thrombosis) or may accompany some acute inflammatory affection of the cranial structures ("phlebitic" or "secondary" thrombosis).

superior longitudinal sinus follows the sagittal suture along the top of the skull to the torcular IIerophilii, situated at the occipital prominence. At this point it divides into several other sinuses; the occipital sinus, which passes downward and empties into the occipital vein; the straight sinus, which passes forward and, after receiving the blood from the vena inagna Galeni which drains the cho rioid plexus, empties into the inferior longitudinal sinus (falciformis minor) which courses along the lower border of the falx cerebri; the two transverse sinuses on each side, which pass close to the petrous portion of the mastoid bone and empty directly into the jugular veins. The transverse sinus in front gives off the inferior petrol's sinus between the clivus and the petrous portion of the temporal bone, and the superior petrous sinus at the upper border of the petrous portion; these, after passing around the sella turcica unite to form a large channel, the ca vernous sinus, which communicates with the ocular veins. Besides the venous trunks that have been mentioned, the sinuses, especially the sinus of the falx eerebri, communicate with numerous small veins that perforate the skull at various points. The cerebral sinuses represent cavities of varying width and outline, provided with small valves; they contain minute septa and villi which encroach on the lumen and explain their special tendency to thrombosis.

ar antic sinus thrombosis results from conditions characterized by marked loss of fluid or weakness of the heart, such as severe intes tinal eatarrah, long-continued suppuration, eudoearditis, myocarditis, syphilis and tuberculosis with severe eachexia.

The most frequent seat of the thrombosis is the longitudinal sinus and next to that the transverse sinus. The process may involve most of the cerebral sinuses. The thrombi are at first of a reddish color,

later more yellow ish, of a loose con sistency and very friable; the attach ment to the wall of the sinus, which is butlittlealtered,isat first loose but grad ually the clot grows firmly adherent.

Secondary (phle bitic) sinus throm bosis results from disease of the ear, disease of the bones, suppuration within the cranial cavity, the orbits and suppurative processes in the face (furuncle, erysipelas).

Sinus thrombosis due to diseases of the ear may be situated in the transverse sinuses, especially on the right side, the petrosal or cavern ous sinuses. A phlebitie thrombus is discolored, diffiuent and in a state of decomposition, and the sinus wall exhibits the signs of acute inflam mation, which may extend to the neighboring veins. The occlusion of the sinus and the spread of the inflammation may produce marked changes in the meninges and in the brain. Hypermmia, local or diffuse meningitis, extensive meuingeal haemorrhages, areas of softening, hmmorrhages, brain abscess and hydrocephalus are observed.

The bacteriologic findings are positive not only in marked phle bitic but also in marantic thrombosis (Heubner). When it is remem bered that in the latter form of sinus thrombosis also the primary disease is usually clue to baeterial toxins, itlarfan's refusal to accept the theory of a purely "marantie" thrombosis appears quite justifiable; according to him, every sinus thrombosis is to be regarded as septicamie in char acter, and lie distinguishes only between those forms which are due to a local cerebral lesion and those which result from general diseases. From this point of ViCW we are justified in classifying sinus thrombosis among the inflammatory diseases of the central nervous system.

The symptoms of sinus thrombosis may be completely masked by the symptoms of the existing disease. This is particularly the case in so-called marantic thrombosis, because the convulsions or loss of con sciousness to which they give. rise are very apt to be regarded as the forerunners of death.

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