Is measurement of d-dimer useful in the diagnosis of cerebral venous thrombosis?
Abstract
Background: The diagnosis of cerebral venous thrombosis (CVT) is a challenge because its clinical presentation is variable, brain CT may be normal, and MRI is not always available. Furthermore, early treatment may be effective. As d-dimer (DD) measurement is a sensitive test for the exclusion of venous thromboembolism, the authors studied whether this test could be useful in the diagnosis of CVT.
Methods: A prospective study of 54 consecutive patients with headaches suggestive of CVT was conducted between October 2000 and September 2002. DD levels were tested for all patients in the emergency room before brain CT or MRI was performed.
Results: Twelve (22%) of the 54 patients had CVT, and 10 (83%) of these 12 patients had DD level of >500 ng/mL (sensitivity of 83% and negative predictive value of 95%). Two patients with confirmed CVT and DD of <500 ng/mL had a history of chronic headache of >30 days’ duration. In the 42 patients without confirmed CVT, only 4 patients had DD level of >500 ng/mL (specificity of 90% and positive predictive value of 71%).
Conclusions: DD test is useful in the diagnosis of acute CVT. A value below 500 ng/mL makes acute thrombosis unlikely.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Bousser MG, Chiras J, Bories J, Castaigne P. Cerebral venous thrombosis—a review of 38 cases. Stroke . 1985; 16: 199–213.
2.
Bousser MG. Cerebral venous thrombosis: diagnosis and management. J Neurol . 2000; 247: 252–258.
3.
Cantu C, Barinagarrementeria F. Cerebral venous thrombosis associated with pregnancy and puerperium. Review of 67 cases. Stroke . 1993; 24: 1880–1884.
4.
Daif A, Awada A, Al-Rajeh S, et al. Cerebral venous thrombosis in adults: a study of 40 cases from Saudi Arabia. Stroke . 1995; 26: 1193–1195.
5.
Fukutake T, Shimoe Y, Hattori T. Dizziness when eating: an unusual isolated presentation of cerebral venous thrombosis. Intern Med . 2001; 40: 961–963.
6.
Sztajzel R, Coeytaux A, Dehdashti AR, Delavelle J, Sinnreich M. Subarachnoid hemorrhage: a rare presentation of cerebral venous thrombosis. Headache . 2001; 41: 889–892.
7.
de Bruijn SFTM, Stam J, Kapelle LJ. Thunderclap headache as first symptom of cerebral venous sinus thrombosis. Lancet . 1996; 348: 1623–1625.
8.
Biousse V, Ameri A, Bousser MG. Isolated intracranial hypertension as the only sign of cerebral venous thrombosis. Neurology . 1999; 53: 1537–1542.
9.
Newman LC, Lipton RB. Emergency department evaluation of headache. Neurol Clin . 1998; 16: 285–303.
10.
Silberstein SD. Evaluation and emergency treatment of headache. Headache . 1992; 32: 369–404.
11.
Bousser MG. Cerebral venous thrombosis: nothing, heparin, or local thrombolysis. Stroke . 1999; 30: 481–483.
12.
Einhaupl KM, Villringer A, Meister W, et al. Heparin treatment in sinus venous thrombosis. Lancet . 1991; 338: 597–600.
13.
de Bruijn SFTM, Stam J. Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis. Stroke . 1999; 30: 484–488.
14.
Perrier A, Desmarais S, Miron MJ, et al. Non-invasive diagnosis of venous thromboembolism in outpatients. Lancet . 1999; 353: 190–195.
15.
Brill–Edwards P, Lee A. d-Dimer testing in the diagnosis of acute venous thromboembolism. Thromb Haemost . 1999; 82: 688–694.
16.
Bounameaux H, de Moerloose P, Perrier A, et al. Plasma measurement of d-dimer as diagnostic aid in suspected venous thromboembolism: an overview. Thromb Haemost . 1994; 71: 1–6.
17.
Goldhaber SZ, Simons GR, Elliot CG, et al. Quantitative plasma d-dimer levels among patients undergoing pulmonary angiography for suspected pulmonary embolism. JAMA . 1993; 270: 2819–2822.
18.
de Moerloose P, Desmarais S, Bounameaux H, et al. Contribution of a new, rapid, individual and quantitative automated d-dimer ELISA to exclude pulmonary embolism. Thromb Haemost . 1996; 75: 412–416.
19.
de Moerloose P, Bounameaux H, Perrier A, Reber G. Performances of the VIDAS d-dimer new assay for the exclusion of venous thromboembolism. Thromb Haemost . 2001; 85: 185–186.
20.
Tardy B, Tardy–Poncet B, Viallon A, et al. d-Dimer levels in patients with suspected acute cerebral venous thrombosis. Am J Med . 2002; 113: 238–241.
21.
Elias A, Bonfils S, Daoud–Elias M, et al. Influence of long term oral anticoagulants upon prothrombin fragment 1+2, thrombin–antithrombin III complex and d-dimer levels in patients affected by proximal deep venous thrombosis. Thromb Haemost . 1993; 69: 302–305.
22.
Sié P, Cadroy Y, Elias A, Boccalon H, Boneu B. d-Dimer levels in patients with long-term antecedents of deep venous thrombosis. Thromb Haemost . 1994; 72: 161–162.
23.
Quattrone A, Gambardella A, Carbone AM, et al. A hypofibrinolytic state in overweight patients with cerebral venous thrombosis and isolated intracranial hypertension. J Neurol . 1999; 246: 1086–1089.
24.
Chabloz P, Reber G, Boehlen F, Hohlfeld P, de Moerloose. TAFI antigen and d-dimer levels during normal pregnancy. Br J Haematol . 2001; 115: 150–152.
25.
Beckham JC, Caldwell DS, Peterson BL, et al. Disease severity in rheumatoid arthritis: relationships of plasma tumor necrosis factor-alpha, soluble interleukin 2-receptor, soluble CD4/CD8 ratio, neopterin, and fibrin d-dimer to traditional severity and functional measures. J Clin Immunol . 1992; 12: 353–361.
26.
Ben RJ, Feng NH, Ku CS. Meningoencephalitis, myocarditis and disseminated intravascular coagulation in a patient with scrub typhus. J Microbiol Immunol Infect . 1999; 32: 57–62.
Information & Authors
Information
Published In
Copyright
© 2003.
Publication History
Received: February 25, 2003
Accepted: June 13, 2003
Published online: October 27, 2003
Published in print: October 28, 2003
Authors
Metrics & Citations
Metrics
Citations
Download Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.
Cited By
- Diagnostic and Therapeutic Challenges of Concurrent Intracranial Hemorrhage and Cerebral Venous Thrombosis in a Patient With Acute Lymphoblastic Leukemia: A Case Report and Literature Review, Cureus, (2023).https://doi.org/10.7759/cureus.37482
- Analysis of 6 pediatric nephrotic syndrome cases with complications of cerebral sinovenous thrombosis and literature review, Frontiers in Pediatrics, 11, (2023).https://doi.org/10.3389/fped.2023.1226557
- Cerebral venous thrombosis and the importance of farmacological history, Neurologie pro praxi, 23, 5, (418-420), (2022).https://doi.org/10.36290/neu.2021.078
- High D-Dimer Concentration Is a Significant Independent Prognostic Factor in Patients with Acute Large Vessel Occlusion Undergoing Endovascular Thrombectomy, World Neurosurgery, 160, (e487-e493), (2022).https://doi.org/10.1016/j.wneu.2022.01.052
- Pathogenesis and Management in Cerebrovenous Outflow Disorders, Aging and disease, 12, 1, (203), (2021).https://doi.org/10.14336/AD.2020.0404
- Blood Biomarkers in the Diagnosis of Acute Stroke, Precision Medicine in Stroke, (163-189), (2021).https://doi.org/10.1007/978-3-030-70761-3_8
- Zerebrale Sinus- und Venenthrombosen, Klinische Neurologie, (915-929), (2020).https://doi.org/10.1007/978-3-662-60676-6_150
- Cerebral venous thrombosis in adults, Vasa, 48, 6, (473-482), (2019).https://doi.org/10.1024/0301-1526/a000788
- Cerebral Venous Thrombosis, Textbook of Stroke Medicine, (250-263), (2019).https://doi.org/10.1017/9781108659574.015
- Zerebrale Venen- und SinusthromboseCerebral venous and sinus thrombosis, Der Nervenarzt, 90, 4, (379-387), (2019).https://doi.org/10.1007/s00115-018-0654-6
- See more
Loading...
View Options
Get Access
Login options
Check if you have access through your login credentials or your institution to get full access on this article.
Personal login Institutional LoginPurchase Options
Purchase this article to get full access to it.