What is thrombosis of the superior longitudinal sinus of the brain, the pathology that was diagnosed in Altamirano: could it be prevented?

By Facundo Rodríguez, neurosurgeon from Fleni (MN 102.861)

We all saw what happened to Javier Altamirano, the Estudiantes player who collapsed on Sunday while playing the match against Boca. And this episode that many have observed in the field and on television deserves to be explained in a didactic way so as not to generate panic and provide scientific clarity. Even taking into account that this is a rare case, because it is not common to have an epileptic seizure due to thrombosis of a cerebral sinus.

Sinuses are thick veins on the surface of the brain. and all the cerebral venous blood flows into them. They are like the tubes where all the venous flow of the brain goes.

Blood enters the brain through the arteries and then leaves through the veins.. These veins discharge all their contents into the dural or venous sinuses. They are not real veins, because their walls are composed of the dura mater, a membrane that is part of the meninges. This is how the dynamics of cerebral blood flow occurs.

In the skull we can find many of these venous sinuses. The sagittal or superior longitudinal sinus, which runs along the midline between the two hemispheres, is one of the largest.

Almost all the veins on the lateral surface of the brain drain their contents into the sagittal or superior longitudinal sinus, where according to the medical report released by Estudiantes the thrombosis that generated the Altamirano crisis occurred.

Thrombosis is basically an occlusion of the sinus due to a thrombus. Just as a heart attack occurs when an artery is blocked, here in Altamirano it happened that the superior longitudinal sinus suffered an obstruction. So the blood was not drained properly and this resulted in blood accumulation, inflammation and increased intracranial pressure, which can lead, among other things, to an episode like this. Seizures may be one of the forms of clinical presentation.

Let’s imagine a clogged pipe that cannot drain liquids. The sagittal sinus is, in order of frequency, together with the transverse sinus, the one that suffers most from this type of pathology, which is thrombosis.

Now that we know what happened to the player, It is necessary to determine the cause that generated this thrombosis in that cerebral sinus. It is assumed that a young 24-year-old athlete in good cardiovascular condition should have less predisposition, but is more exposed to trauma. In any case, it should be clear that no one is exempt from this event, because it falls within the general rules of scientific statistics.

Could the episode suffered by Altamirano have been prevented or avoided?

If a person has no symptoms, they may not be suspected of having sinus thrombosis.

To diagnose sinus thrombosis, in addition to the symptoms, complex studies must be performed, such as tomography, magnetic resonance imaging or cerebral angiography, which are not part of the usual routine. The patient must be studied to determine the cause that generated the thrombosis and from there plan the specific treatment.