Cerebral venous and sinus thrombosis diagnosis: preliminary study of clinical picture and D-dimer concentration...

We investigated whether D-dimer (DD) concentration is elevated in cerebral venous and sinus thrombosis (CVST), as has been reported in the literature.

CVST is a disease with variable clinical presentations and a challenging diagnosis. We looked into whether D-dimer concentration might be an indicator of CVST, and the need for neuroimaging tests correlated with clinical factors.

We included all consecutive patients (mean age 41.6 years) with CVST treated in our neurology department from 2014 to 2018 whose DD levels had been measured. DD concentrations were categorised as normal (≤ 0.5 μg/ml) or elevated ( > 0.5 μg/ml). Appropriate imaging confirmed the diagnosis of CVST. The results were compared to those of a control group consisting of 22 age- and sex-matched patients (mean age 40 years) with a diagnosis of primary headache (tension type or migraine) hospitalised to exclude secondary causes.

In 20 patients in the CVST study group, median level of DD was 1.0 + 0.57 μg/ml (range 0.19-2.45 μg/ml), compared to the control group's mean DD level of 0.50 + 0.45 μg/ml (range 0.15-1.73 μg/ml), with p < 0.005. Higher DD levels were associated with complications of the disease and fatal course (p < 0.005). One female and one male patient died because of CVST with DD levels of (respectively) 2.45 and 1.80 μg/ml - the two highest concentrations in our study group.

DD concentration, especially in headache patients, may be a factor to predict CVST and an indicator for further diagnostic procedures with venography. But in clinical practice, low levels of DD cannot be taken to exclude CVST.