Cavernous sinus thrombosis pathophysiology

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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]

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]

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].

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

  • 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.

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.

• Incidence is unknown, but is generally uncommon, ~0.08% of autopsies in one study.

• Pathogenetic factors:

  • Venous stasis
  • Hypercoagulability
  • Vessel wall changes
  • Embolization

References

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