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SINUS THROMBOSIS                                  367

have been employed as an aid to diagnosis, but have not been found of
great value, because: (1) living organisms are not always present in the
peripheral veins even in cases of undoubted sinus thrombosis, and (2) the
organisms may not show a growth until 48 hours have elapsed by which
time in the majority of cases immediate operative interference has been

The general aspect of the patient differs markedly in the three main
intracranial complications—purulent meningitis, brain abscess and septic
sinus thrombosis. In meningitis the patient is anxious, frightened and has
a very severe headache. In brain abscess he is usually dull and apathetic,
although here also the headache is severe. In septic sinus thrombosis the
patient is bright and, when questioned, usually says he feels well except, of
course, during or just after a rigor.

PROGNOSIS. The prognosis of transverse sinus thrombosis is much more
favourable since the introduction of antibiotics and its incidence reduced
thereby. It is more favourable than brain abscess if an operation is performed
before systemic infection has occurred and if there is no other intracranial
complication. With antibiotics and timely surgery a cure is to be expected.

TREATMENT. As in the other intracranial complications, energetic treatment
by antibiotics is carried out and in many cases operative treatment is quite
unnecessary, but when active surgical intervention is required this consists
of removing the primary focus of disease, by performing a cortical mastoid-
ectomy in cases due to acute middle ear suppuration, and a radical operation

Fig. 191. Exposure of sigmoid sinus.

in cases of chronic suppuration. If sinus thrombosis be present, there is
usually excessive bleeding from the bone at the mastoid operation. In every
case which shows symptoms suggestive of extradural perisinus abscess or
sinus thrombosis, the sigmoid sinus should be exposed (Fig. 191) until the
healthy wall is seen.

If an extradural perisinus abscess is found, with healthy red granulations
on the sinus wall, and if only one rigor has occurred it is advisable to leave
the wound open and await developments. Nor should the sinus be opened
if the sinus wall returns evenly and instantly to its previous shape after
being compressed with a blunt probe which is suddenly released. The sinus
should be opened if the temperature rises over 38 °C for two successive