Can otitis media also cause cerebral thrombosis? Understanding the true nature of cerebral venous sinus thrombosis

Author: Wang Daming, Chief Physician of Beijing Hospital

Reviewer: Hu Wenli, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Among many cerebrovascular diseases, cerebral venous sinus thrombosis has become an area that clinicians and patients need to pay attention to due to its low incidence and unique pathophysiological characteristics. Although cerebral venous sinus thrombosis, that is, thrombosis in the cerebral venous sinus, only accounts for 1% of all strokes, once it occurs, it can quickly cause a series of serious symptoms and even endanger life.

Cerebral venous sinuses, a term that sounds a little unfamiliar, are actually the "behind-the-scenes heroes" that are indispensable for the healthy functioning of our brain. Cerebral venous sinuses are part of the cerebral venous return system, responsible for draining blood from the brain back to the heart. They are located between the meninges and the skull, and have different shapes, some are square, some are flat, and some are wide, which are very different from the regular blood vessel shape. This special structure not only provides an additional protective barrier for the brain, but also ensures that blood from the brain can flow to the heart stably and efficiently, maintaining normal blood circulation in the brain.

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However, when certain unfavorable factors lead to an imbalance between blood coagulation and anticoagulation mechanisms, blood clots may form inside the cerebral venous sinus, which is called cerebral venous sinus thrombosis. Once a blood clot is formed, it will hinder the blood return to the brain, causing blood to accumulate in the brain, which in turn causes a series of serious symptoms such as brain swelling and increased intracranial pressure.

The formation of cerebral venous sinus thrombosis is a complex process involving the interaction of multiple factors. Among them, the imbalance of blood coagulation and anticoagulation mechanisms is the most core factor. When the body is in a special state such as systemic inflammatory response, massive blood loss, trauma, etc., the coagulation mechanism may be abnormally enhanced, thereby inducing the formation of blood clots. In addition, long-term use of contraceptives, hemostatic drugs, etc. may also increase the risk of venous sinus thrombosis.

It is worth noting that local infections such as otitis media may also become the "trigger" of cerebral venous sinus thrombosis. When the organs around the cerebral venous sinus such as the middle ear and mastoid process become infected, the inflammation may spread to the cerebral venous sinus area, affecting local blood circulation and inducing thrombosis. Therefore, timely and effective treatment of infectious diseases such as otitis media is particularly important.

Early identification of cerebral venous sinus thrombosis is crucial for patients. Headaches, especially when accompanied by blurred vision, nausea and vomiting, are typical signs of the disease. Headaches vary in nature and may be acute, severe pain, or continuous or intermittent. Decreased vision and blurred vision are also important signs. In addition, increased intracranial pressure may also cause nausea and vomiting, and in severe cases, even impaired consciousness, drowsiness or coma. Therefore, when a new severe headache occurs, especially when accompanied by vision problems and gastrointestinal symptoms, you should seek medical attention immediately to rule out cerebral venous sinus thrombosis.

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In terms of diagnosis, the doctor will first understand the patient's medical history and symptoms in detail, and then conduct a series of examinations to confirm the diagnosis. Conventional examination methods such as fundus examination and lumbar puncture can help to preliminarily evaluate changes in intracranial pressure. Imaging examinations such as CT venography (CTV) and magnetic resonance venography (MRV) can more clearly present the morphology of brain veins and venous sinuses, providing an important basis for diagnosis. However, as the "gold standard" for diagnosing cerebral venous sinus thrombosis, cerebral venous angiography (DSA) is irreplaceable in its accuracy and can intuitively display the pathological conditions of cerebral veins and venous sinuses.