The cerebral symptoms are not very characteristic: they consist in headache, vomiting, crying out at night, con vulsions, somnolence and coma. In addition, there may be strabis mus, nystaginus, dilata tion of the pupils and, more rarely, palsies in other parts of the body. In an infant the sudden occurrence of convul sions followed by som nolence is very sugges tive of sinus thrombosis.
The temperature is of con.siderable diag nostic importance. In septic sinus thrombosis it may attain extreme degrees and also be characterized by repeated chills. If, in addition to a sudden extreme rise of temperature, the above-mentioned cerebral symptoms are present, and if this occurs in the course of a purulent otitis, for example, the change in the patient's condition may be sufficiently definite to suggest the onset of sinus disease.
Local (edema and the presence of secondary thrombi from extension are important signs for the diagnosis of a sinus thrombosis and afford direct information in regard to the character and seat of the disease. Thus, thrombosis of the transverse sinus produces cederna behind the ma.stoid proces.s and, according to Jansen, not infrequently also throm bosis of the upper portion of the jugular vein; the thrombosis in the latter CaP sometimes be felt or may betray itself by pain when the head is moved, by persistent lateral inclination of the head and by dysphagia.
By making pressure in the jugular foramen it may cause disease of the nerves which pass through the foramen—the vague, the spinal accessory and glossopharyngeal—and bulbar symptoms, and may indeed be the direct cause of death. Occlusion of the longitudinal sinus is followed by swelling of the veins in the skull and in the scalp. Thrombosis of the cavernous sinus may conceivably produce swelling of the eyelids (which may be unilateral), inflammation of the orbital contents, dis turbance of the oecular muscles and trifacial neuralgia. These local
symptoms are, however, frequently absent and cannot therefore be relied upon for the diagnosis. In many eases a general pyssmia may be the only sign of an existing phlebitis and the cerebral symptoms may be quite inconspicuous.
The course of sinus phlebitis is almost always rapidly fatal. Rarely, particularly in the marantie form, the disease may last several weeks before death °emus. Complications due to secondary disease, parti cularly pulmonary embolism, may occur. Recovery is extremely rare and, owing to the uncertainty of the diagnosis, its frequency is difficult to estimate. There is, however, a possibility of a collateral circulation being established (Holscher), or the sinus may become obliterated by fibrous tissue with secondary hydrocephalus (Marton), constituting a temporary recovery, as has been proven by subsequent autopsies. According to Fischer inflammatory disease of the sinuses ending in recovery is one of the causes of eerebral infantile palsy.
Operation should always be considered, partieularly in cases of phlebitic sinus thrombosis. In eases of otitis media the operator often finds, on opening the mastoid process, that the lateral sinus is throm based and thus performs the operation, although he had not originally intended to do so. Some surgeons combine the operation for sinus thrombosis with ligation of the jugular vein. Numerous results have already reported from this operation and they are not bad; 58.4 per cent. of recoveries according to Korner. For the technic of the various methods of operation the reader is referred to K5rner and Jansen.