Diseases Of The Nose Throat And Ear

SINUS THROMBOSIS

365

the temperature. In the intervals between the rigors, the patient may be
free from symptoms; but in some cases, especially later in the disease, the
temperature remains elevated. Headache and vomiting are sometimes met
with; the tongue presents a very significant appearance and is usually dry
and brown; there may be herpes or sordes on the lips; the spleen may be
enlarged; a choked optic disk occurs in a considerable proportion of cases.
Lumbar puncture demonstrates raised fluid pressure, particularly when

Fig. 189. Horizontal section through thrombosed sigmoid sinus showing extradural perisinus abscess.
1, Normal dura of sinus wall; 2, Sinus wall replaced by granulation tissue; 3, Position of perisinus
abscess; 4, Laminated clot in sigmoid sinus, breaking down in centre; 5, Normal dura of cerebellar
surface of the sigmoid sinus.

complete occlusion is present and the Tobey-Ayer test is positive. Pressure
on the jugular vein of the normal side produces a rise of pressure of cerebro-
spinal fluid in the manometer which is connected to the lumbar puncture
needle. Compression of the vein on the affected side produces little or no
rise of pressure. Occasionally oedema is manifest in the neighbourhood of
the mastoid emissary vein (Griesinger's sign). When the thrombosis extends
into the neck, torticollis may supervene, and tenderness may be complained
of along the line of the jugular vein, while a swelling, due to inflammatory
enlargement of the cervical lymphatic glands, is sometimes found. The
thrombosis may extend along the superior or inferior sinuses to the cavernous
sinus.

As a result of the escape of portions of the clot into the general circulation,
septic pneumonia and empyema (infarction) may arise, or metastatic ab-
scesses may appear in other parts of the body, especially in the subcutaneous
tissues or in the bones and joints. If the septic particles are large they are