Cavernous sinus thrombosis pathophysiology
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Cavernous sinus thrombosis Microchapters |
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Differentiating Cavernous sinus thrombosis from other Diseases |
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Cavernous sinus thrombosis pathophysiology On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
Pathophysiology
Physiology
The normal physiology of [name of process] can be understood as follows:
Pathogenesis
- The exact pathogenesis of [disease name] is not completely understood.
OR
- It is understood that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
- [Pathogen name] is usually transmitted via the [transmission route] route to the human host.
- Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
- [Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
- The progression to [disease name] usually involves the [molecular pathway].
- The pathophysiology of [disease/malignancy] depends on the histological subtype.
Genetics
[Disease name] is transmitted in [mode of genetic transmission] pattern.
OR
Genes involved in the pathogenesis of [disease name] include:
- [Gene1]
- [Gene2]
- [Gene3]
OR
The development of [disease name] is the result of multiple genetic mutations such as:
- [Mutation 1]
- [Mutation 2]
- [Mutation 3]
Associated Conditions
Gross Pathology
On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Microscopic Pathology
On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
References
Pathophysiology
Anatomy
- Anatomy:
- Cerebral veins --> Dural sinuses --> Internal jugular veins
- The Cerebral veins include:
- Superficial cerebral veins
- Anatomy quite variable
- Deep cerebral veins
- Veins of the posterior fossa
- Superficial cerebral veins
- The Dural sinuses most commonly affected by thrombosis are:
- Superior sagital sinus
- Drains most of cortex
- Also fed by scalp emissary veins
- Contains most of arachnoid villi responsible for draining CSF – obstruction increases intracerebral pressure
- Superior sagital sinus thrombosis may only result in massive brain edema.
- Lateral sinus
- Drains cerebellum, brain stem, posterior cerebral hemispheres, middle ear
- Near mastoid and inner ear, and susceptible to infections there
- Cavernous sinus
- Drains ophthalmic veins, anterior base of brain
- Near, and susceptible to infection of face, sphenoid sinuses, teeth, and ear – infection (particularly with Staph aureus, fungus) is leading cause of cavernous sinus thrombosis, and cavernous sinus thrombosis is most common cerebral venous thrombosis.
- Near oculomotor nerve, ophthalmic nerve, trigeminal nerve, abducens nerve, carotid artery and its surrounding sympathetic plexus.
- Superior sagital sinus
Pathogenesis
- Cerebral venous thrombosis usually leads to parenchymal infarction, though simple intracranial hypertension may be the only finding.
- Venous infarction affects both the cortex and adjacent white matter, and are often hemorrhagic.
- Association with subarachnoid hemorrhage, subdural hemorrhage, intracerebral hematoma
- Classic presentation is extensive bilateral hemorrhagic infarcts in both superior and internal parts of both hemispheres due to thrombosis of the superior sagital sinus and its cortical veins.
- Venous infarction affects both the cortex and adjacent white matter, and are often hemorrhagic.
- Incidence is unknown, but is generally uncommon, ~0.08% of autopsies in one study.
- Pathogenetic factors:
- Venous stasis
- Hypercoagulability
- Vessel wall changes
- Embolization