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Do normal D-dimer levels reliably exclude cerebral sinus thrombosis?
Christoph M Kosinski1, Michael Mull, Michael Schwarz
1Department of Neurology, Universitätsklinikum Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany. CKosinski@ukaachen.de
Insights
Normal D-dimer levels effectively rule out cerebral sinus thrombosis (CST) in patients presenting with acute headache. This diagnostic marker aids in excluding CST, potentially preventing serious complications.
Area of Science:
- Neurology
- Diagnostic Imaging
- Hematology
Background:
- Cerebral sinus thrombosis (CST) is a critical diagnosis for acute headache patients.
- Early CST diagnosis is vital for preventing morbidity and mortality.
- Advanced imaging for CST exclusion is not universally accessible.
Purpose of the Study:
- To evaluate the diagnostic accuracy of D-dimer testing in excluding cerebral sinus thrombosis (CST).
- To determine if D-dimer levels can serve as a reliable screening tool for suspected CST.
Main Methods:
- Prospective, multicenter study over 2.5 years.
- Inclusion of emergency department patients with symptoms suggestive of CST.
- Diagnosis confirmed by advanced neuroimaging (MRV, CT venography, DSA); D-dimer levels measured on admission.
Main Results:
- 343 patients included; CST diagnosed in 35.
- D-dimer sensitivity for CST was 97.1% with a negative predictive value of 99.6%.
- D-dimer levels correlated positively with thrombosis extent and negatively with symptom duration.
Conclusions:
- D-dimer measurement is a valuable tool in the diagnostic workup of suspected cerebral sinus thrombosis (CST).
- A normal D-dimer result significantly reduces the likelihood of CST.
Background And Purpose:
Cerebral sinus thrombosis (CST) needs to be considered in the differential diagnosis of all patients with acute headache. Early diagnosis is essential because early treatment may prevent morbidity and may even be life-saving. Definite exclusion, however, needs advanced neuroradiologic diagnostics, which are not readily available in many hospitals. Because measurement of D-dimers has been demonstrated to be helpful in excluding thromboembolic disease, our aim was to investigate whether D-dimers would be also sensitive enough to exclude CST.
Methods:
We undertook a prospective multicenter study over a 2.5-year period including all patients who came to the emergency departments with symptoms suggestive of CST. All patients were diagnosed either by magnetic resonance venography, spiral computed tomography scan venography, or intra-arterial digital subtraction angiography. D-dimer levels were measured at admission and analyzed by the same method in all patients.
Results:
A total of 343 patients were included. CST was diagnosed in 35 patients, of whom 34 had D-dimers above the cutoff value (>500 microg/L). From the 308 patients not having CST, D-dimers were elevated in 27. Sensitivity of D-dimers was 97.1%, with a negative predictive value of 99.6%. Specificity was 91.2%, with a positive predictive value of 55.7%. D-dimers were positively correlated with the extent of the thrombosis and negatively correlated with the duration of symptoms (Spearman rank correlation coefficients 0.76, -0.58, respectively).
Conclusions:
D-dimer measurement is useful in patients with suspected CST. Normal D-dimers make the presence of CST very unlikely.
