Sigmoid sinus thrombophlebitis
Introduction
Introduction to sigmoid sinus thrombophlebitis Thrombophlebitis of sigmoid sinus is a sigmoid sinusitis with thrombosis. It is more common on the right side and is a common otogenic intracranial complication. Typical people have chills and chills, followed by high fever, body temperature can reach above 40 °C, sweating a lot after a few hours, body temperature suddenly drops to normal. Symptoms are relieved after the body temperature drops. The above symptoms occur 1 or 2 times a day, and must be differentiated from malaria, typhoid and other diseases. basic knowledge The proportion of illness: 0.012% Susceptible people: no special people Mode of infection: non-infectious Complications: subdural abscess meningitis
Cause
Cause of sigmoid sinus thrombophlebitis
This disease is mostly caused by the septic sinus bone plate directly in the middle ear mastoid sinus disease, first to form perivascular inflammation, so that the intima is rough, blood flow is slow, fibrin, red blood cells and platelets adhere to the intima to form the sinus wall Thrombosis, thrombosis gradually increases, forming an embolism, which can be extended upward to the supraspinal sinus, the inferior sinus, the cavernous sinus, etc., which can extend down to the jugular bulb, the internal jugular vein, the thrombus infection, the central necrotic liquefaction, and the infected emboli fall off. Blood circulation can cause sepsis sepsis and purulent diseases of distant organs, such as common lung abscess. After the infection is controlled, small thrombus can heal itself, large thrombosis occurs, and later angiogenesis can occur. Re-connected.
Prevention
Prevention of sigmoid sinus thrombophlebitis
The disease is an acute, chronic suppurative otitis media complication, so the prevention and treatment of acute, chronic suppurative otitis media is the key to prevent this disease, the prognosis of this disease is poor before the application of antibiotics, the mortality rate is about 20-30%, broad-spectrum effective in recent years The use of antibiotics, acute suppurative otitis media with the disease has gradually decreased, and its mortality has also been significantly reduced.
Complication
Complications of sigmoid sinus thrombophlebitis Complications subdural abscess meningitis
The thrombus in the sigmoid sinus can still be upward and the lower end extends, and can extend down to the jugular bulb, the internal jugular vein, up to the superior sinus, the inferior sinus, the sagittal sinus and the transverse sinus, the cavernous sinus, etc. This area is complicated by inflammation. If the embolus falls off, it can spread to the whole body with blood flow, causing suppurative infection and sepsis in distant organs. If sigmoid sinus thrombophlebitis spreads to adjacent tissues, it can cause hard. Subcerebral abscess, meningitis, cerebellar abscess and other complications, can lead to death.
Symptom
Symptoms of sigmoid sinus thrombosis venous symptoms common symptoms neck pain chills low fever high fever apathetic edema
(1) Systemic symptoms: typical people have chills, chills, followed by high fever, body temperature can reach above 40 °C, a lot of sweating after a few hours, body temperature suddenly drops to normal, symptoms are relieved after the body temperature drops, the above symptoms daily Attacks 1-2 times, must be identified with malaria, typhoid and other diseases, due to the application of a large number of antibiotics, this body temperature change can become atypical, manifested as low fever, long-term illness can occur severe anemia, mental wilting.
(B) local symptoms and signs: infection spread to the mastoid blood vessels, the internal jugular vein and its surrounding lymph nodes, after the affected side of the ear, post-occipital and neck pain, mild edema behind the mastoid, ipsilateral neck Touching the cord-like mass, tenderness is obvious.
Examine
Examination of sigmoid sinus thrombophlebitis
(1) Laboratory examination: white blood cells are significantly increased, polymorphonuclear leukocytosis is increased; blood is drawn for bacterial culture during chills and high fever, which may be positive, and routine examination of cerebrospinal fluid is normal.
(B) Tobey-Ayer test; lumbar puncture, measurement of cerebrospinal fluid pressure, compression of the internal jugular vein, cerebrospinal fluid pressure rises rapidly, can exceed the original pressure of 1 to 2 times, and then oppress the affected internal jugular vein, if the sigmoid sinus With occlusive thrombosis, there is no significant change or slight increase in cerebrospinal fluid pressure.
(C) fundus examination: edema can occur in the side of the nipple, retinal vein dilatation, compression of the normal internal jugular vein, the fundus vein can be dilated, if the jugular vein does not change when the internal jugular vein is pressed, indicating that the jugular vein has an occlusive thrombus Formed, this method is called the Crowe test.
Diagnosis
Diagnosis and differentiation of sigmoid sinus thrombophlebitis
After the acute attack, the disease may have typical symptoms such as chills, chills, high fever, etc., which need to be differentiated from malaria and typhoid:
(1) If malaria is not typical, it can also occur in chills and chills, especially in the case of vivax, and its onset is also periodic. Therefore, if you suspect these two diseases in the clinic, you can pass the blood smear. Plasmodium is detected, and if the result is positive, it can be identified. If it is negative, and other symptoms do not support sigmoid sinus thrombophlebitis, bone marrow smear can be performed.
(2) Typhoid fever: Patients with typhoid fever may have similar clinical manifestations. At this time, the fat test can be performed, and the positive person is typhoid.
