Peculiarities of the differential diagnosis of different types of cerebral sinus and vein thrombosis in patients with ENT organs involvement

Abstract

The paper is devoted to the problems of diagnosis of septic and aseptic forms of central venous thrombosis. The aim of the study was to study the clinical manifestation and lesions of the ear, nose and throat, in patients with aseptic central venous thrombosis in order to increase the efficiency of differential diagnosis of various forms of thrombosis and to determine the tactics of further treatment of patients with this disease. Variants of manifestation of lesions of Lesions of the ear, nose and throat were studied in 14 patients with aseptic central venous thrombosis who were hospitalized for the period from 2016 to 2019, the results of their ophthalmological and neurological examination, as well as laboratory studies are given. It was found that among patients with cerebral venous thrombosis in most cases (82.4%) various changes in otolaryngological status were detected, of which 21.4% of cases – with septic lesions of the ENT organs, 78.6% of cases – with aseptic changes. During the examination, the character of these pathological changes in otolaryngology status in non-purulent lesions of the ENT organs (swelling of the soft tissues of the face, sinus mucosa or their necrosis, dysfunction of the pharyngeal muscular system, neurosensory deafness) were formulated, which could be explained by secondary ischemic tissue changes and impaired venous outflow of the soft tissues of the face. Also, the absence of a primary purulent focus of in­fection and septic changes in peripheral blood and cerebrospinal fluid in patients with a clinically confirmed diagnosis of CVT, confirmed the aseptic (primary) form of the disease. Patients with aseptic CVT are assigned direct anti­coagulant therapy and symptomatic therapy depending on the presence of cerebral and focal neurological symptoms, which is radically different from the therapeutic tactics used by patients with septic CVT. Thus, when conducting a differential diagnosis of different forms of CVT, for the choice of therapeutic strategy, in addition to the standard algorithm of examination of the patient should take into account the nature of changes in otolaryngological status.

Keywords

• central venous thrombosis
• aseptic thrombosis of the cavernous sinus
• differential diagnostic of thrombosis