---
title: "Sigmoid Sinus Thrombosis"
description: "ENT notes on Sigmoid Sinus Thrombosis - causes, pathology, clinical features, investigations, and treatment."
source: "The ENT Resident"
author: "Dr. Mausumi Das"
canonical_url: "https://www.theentresident.com/ent-notes-lectures/sigmoid-sinus-thrombosis"
categories: ["Otology"]
video: "https://www.youtube.com/watch?v=4T5bIMVaIrs"
image: "https://media.theentresident.com/og-images/sigmoid-sinus-thrombosis.png"
---

# Sigmoid Sinus Thrombosis

ENT notes on Sigmoid Sinus Thrombosis - causes, pathology, clinical features, investigations, and treatment. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=4T5bIMVaIrs

### 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?

---

## About This Note

This free ENT note on Sigmoid Sinus Thrombosis was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/sigmoid-sinus-thrombosis

When citing or referencing this content, please credit The ENT Resident and link to the canonical page above.

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