Chapter 8 - Suppurative intracranial thrombophlebitis

Abstract

This chapter discusses the epidemiology, etiology, pathogenesis, clinical features, diagnosis, and management of suppurative intracranial thrombophlebitis. Septic intracranial venous sinus thrombosis arises as a consequence of infection in the paranasal sinuses and less frequently following infections of the middle ear or mastoid. The most common isolate from the cases of septic intracranial venous thrombosis associated with pericranial infections is Staphylococcus aureus . Suppurative intracranial thrombophlebitis is most frequently the result of pericranial infection. The local infection causes septic thrombophlebitis of veins draining the infected area, with subsequent intracranial extension of the infected thrombus along emissary veins. The cavernous sinuses are the structures most frequently involved in septic venous sinus thrombosis. The transverse sinuses are the second most frequent intracranial venous sinuses to be involved by septic processes. The advent of magnetic resonance imaging (MRI) and then of computed tomography (CT) angiography and venography revolutionized diagnosis of both venous sinus and cortical vein thrombosis, such that MRI and CT venography are currently the diagnostic procedures of choice in detecting venous sinus thrombosis.