Sigmoid Sinus Thrombosis

Sigmoid Sinus Thrombosis

What is Sigmoid Sinus Thrombosis?

Inflammation of the inner wall of the sigmoid (lateral) venous sinus with formation of an intrasinus thrombus.

• Other Names:
  • Lateral sinus thrombophlebitis
  • Otogenic suppurative thrombophlebitis
  • Lateral sinus thrombosis
  • Sigmoid sinus thrombophlebitis

Causes of Sigmoid Sinus Thrombosis

• Complication of:
  • Acute coalescent mastoiditis
  • Masked mastoiditis
  • Cholesteatoma

Pathology – 4 Stages of Sigmoid Sinus Thrombosis

1. Perisinus Abscess

   • Inflammation of outer dural wall
   • Abscess formation in relation to wall

2. Endophlebitis and Mural Thrombus Formation

   • Inflammation spreads to inner wall
   • Deposition of fibrin, platelets → thrombus inside sinus

3. Obliteration and Intrasinus Abscess

   • Thrombus expands, occludes lumen
   • Microorganisms invade → intrasinus abscess → septicemia via septic emboli

4. Extension of Thrombus

   • Proximal: Confluence of sinuses, superior sagittal sinus, cavernous sinus
   • Distal: Mastoid emissary vein, jugular bulb, jugular vein

Common Microorganisms of Sigmoid Sinus Thrombosis

• From acute otitis media:

  • Hemolytic streptococcus
  • Pneumococcus
  • Staphylococcus

• From cholesteatoma:

  • Bacillus proteus
  • Pseudomonas pyocyaneus
  • Escherichia coli
  • Staphylococcus

Clinical Features of Sigmoid Sinus Thrombosis

• General symptoms:

  • High-grade fever (picket fence type with rigor, chills, profuse sweating)
  • Deep ear pain
  • Restlessness
  • Toxic look
  • Neck stiffness
  • Papilledema

• Specific Signs:

  • Picket fence fever
  • Griesinger’s Sign
  • Papilledema
  • Jugular tenderness
  • Progressive anemia and emaciation

• Special Tests

  • Tobey Ayer Test
  • Crowe Beck Test

What is Griesinger sign?

What is Picket fence type of fever?

What is Tobey Ayer Test? How do you perform it? What are the interpretations?

What is Crowe Beck Test? How do you perform it? What are the interpretations?

Investigations of Sigmoid Sinus Thrombosis

• Blood smear
• Blood culture
• Lumbar puncture: Raised CSF pressure, otherwise normal.
• X-ray mastoid: Clouding of air cells, bone destruction in cholesteatoma.
• CECT Temporal Bone/Brain: Delta sign
• MRI / MR Venography

What is Delta sign seen in CECT Brain?

Treatment of Sigmoid Sinus Thrombosis

1. Medical:

   • IV antibiotics
   • Continued at least 1 week post-surgery

2. Surgical:

   • Mastoidectomy (cortical/modified radical/radical) depending on disease

3. Ligation of Internal Jugular Vein:

   • Rarely needed

4. Anticoagulants (rare, selective)

5. Supportive:

   • Blood transfusions for anemia
   • General supportive care

What is the Drug of Choice in Sigmoid sinus thrombosis?

What are the indications of Ligation of Internal jugular vein in Sigmoid sinus thrombosis?

What are the indications of Anticoagulants in Sigmoid sinus thrombosis?

What is the dosage of heaprin in Sigmoid sinus thrombosis?

Complications of Sigmoid Sinus Thrombosis

• Septicemia
• Pyemic abscesses: Lung, bone, joints, subcutaneous tissue
• Intracranial: Meningitis, subdural abscess, cerebellar abscess
• Jugular bulb/vein: IX, X, XI cranial nerve involvement
• Cavernous sinus thrombosis
• Otitic hydrocephalus

What is the Differential Diagnosis of Sigmoid Sinus Thrombosis?