Inflammation of the intra-cranial venous sinuses is due to the spread of infection from a local focus of suppuration; by far the most frequent cause is chronic suppuration in the middle ear. Less common sources of infection are erysipelas of the face or scalp, infective conditions of the mouth or nose, and diseases of the bones of the skull.
The organisms may reach the affected sinus directly by continuity of tissue, as, for instance, when the transverse (lateral) sinus becomes infected from a focus of suppuration in the mastoid process spreading through the bone to the sigmoid groove and involving the walls of the vessel; or they may reach it by extension of thrombosis in a tributary vein—for example, when the superior sagittal (longitudinal) sinus is infected from an anthrax pustule of the lip, which has caused thrombosis of the emissary vein that passes through the foramen cæcum.
The pathological changes are the same as occur in the suppurative form of thrombo-phlebitis in the peripheral veins (Volume I., p. 285). The soft clot that forms adheres to the inflamed wall of the sinus, and, being infected with pyogenic bacteria, it soon undergoes purulent disintegration.
The infective process may spread backward along tributary vessels, and so give rise to cerebral or cerebellar abscess, or to purulent meningitis; or it may spread into the internal jugular vein and lead to the development of a diffuse purulent cellulitis along its course.
General pyæmic infection may take place from pus or bacteria getting into the circulation, either directly or by reversed flow through tributary veins. Infective emboli are liable to lodge in the lung or pleura, and set up pulmonary abscess, gangrene of the lung, or empyema.
Clinical Features.—In all cases, pain in the head, referred to the region of the affected sinus, and so severe as to prevent sleep, is an early and prominent feature. The patient is usually excited, hypersensitive, and irritable in the early stages, and becomes dull and even comatose towards the end. Rigors, followed by profuse perspiration, occur early and increase in frequency as the disease progresses. The temperature is markedly remittent, varying from 103° to 106° F. ([Fig. 196]). The pulse is rapid, small, and thready. Loss of appetite, vomiting, and diarrhœa are almost constant symptoms.
Fig. 196.—Chart of case of Sinus Phlebitis following middle ear disease in a boy æt. 13.
Phlebitis of Individual Sinuses.—The transverse (lateral or sigmoid sinus), from its proximity to the middle ear and mastoid air cells, is that most commonly affected, especially in young adults. With the onset of the phlebitis the discharge from the ear stops; there is severe pain in the ear and violent headache. The temperature rises, but shows marked remissions, and rigors are common. Vomiting is frequently present. Turgescence of the scalp veins draining into this sinus, and œdema over the mastoid, are occasionally observed; but as these signs may accompany various other conditions, they are of little diagnostic value. Not infrequently phlebitis spreads to the internal jugular vein, which may then be felt as a firm, tender cord running down the neck, and the head is held rigid, sometimes in the position characteristic of wry-neck.