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Sinus vein thrombosis

Synonym: sinus thrombosis
German: Sinusvenenthrombose

1 Definition

Sinus vein thrombosis is the definition given to the thrombotic occlusion of a cerebral sinus.

  • ICD10 - Code: I67.6 - Nonpyogenic thrombosis of intracranial venous system

See also: cerebral venous thrombosis

2 Epidemiology

Sinus vein thrombosis occur about 60 times more rarely than than do occlusion of the artery/arteries. Among adults, the incidence is 3-4 cases / 1 million. Among children, this rate is about twice as high, with 7 cases / 1 million. 75% of such patients are women.

3 Causes

In relation to the cause a basic distinction exists between septic or infectious SVT and a bland SVT, which is triggered among other things by already existing diseases, such as coagulopathy/coagulopathies.

The more commonly occurring septic SVT is cavernous sinus thrombosis.

3.1 Infections as cause

3.2 Generalised causes

3.3 Common causes of bland SVT

3.4 Rarer causes of a bland SVT

4 Symptoms

With nearly 1/3 of those affected an SVT runs its course asymptomatically. With the other 2/3 symptoms are ambiguous, in other words not distinct identifiers of one condition, symptoms such as headaches. In a given instance where inflammable SVT is present, acute fever also usually occurs.

4.1 Early symptoms

4.2 Later symptoms

4.3 Full clinical picture

4.4 End consequences

5 Pathophysiology

Not every thrombus needs to automatically lead to clinical symptoms. This is due to the high variability of the venous system of the brain and of the many possible collaterals which are able to allow flow reversal. The essential cause of the symptoms is venous congestion, ie an increase of blood volume. This reduces the perfusion pressure in the veins, which leads to increased cerebral blood volume. As a result of this, intracranial pressure increases while the blood flow decreases locally. Damage to the blood-brain barrier and the increased pressure in the arterial vessels induces vasogenic oedema while the reduced blood flow with hypoxia produces venous heart attack and congestive haemorrhage.

6 Diagnosis

Since the symptoms, as described above, are not unique to SVT, the diagnosis is not easy to make. Management of D-dimer - levels is helpful, but can only support an existing suspicion and not act as confirmation. Therefore, the use of sectioning imaging techniques is essential.

6.1 Cross-sectional imaging

6.2 laboratory diagnostics

6.2.1 CSF/ Spinal Fluid diagnostics

7 Therapy

First drug of choice used is high-dose heparin (3000-5000 IE) intravenous administered as single large dose. Then every day about 20,000 IU of heparin is given until such time as PTT has doubled. Then, usually after 14 days, oral anticoagulants will be administered for at least 6 months. By using phenytoin epileptic seizures are prevented. should intracranial pressure be elevated, mannitol must be given. With septic SVT the infection needs to be treated using antibiotics.

8 Prognosis

In about 85% of cases complete recovery follows. Recurrence rate is about 10% during the first year.

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