Clinical profile of cerebral venous thrombosis in a tertiary care center and utility of D-dimer in its diagnosis

Abstract

Background & Objectives: Cerebral venous thrombosis (CVT) is a rare cause of stroke, occurring commonly in young adults. The variability in the clinical scenario from patient to patient and the lack of specificity of the presenting symptoms of CVT poses a diagnostic challenge. This study aims to analyze the clinical characteristics of patients diagnosed with CVT in comparison to the global profile and explore the diagnostic utility of D-dimer levels as a screening tool in patients with clinical features suspicious of underlying CVT. Methods: This was a hospital-based case-controlled study, included 50 imaging proven patients with CVT and age and sex matched healthy controls. Demographic details were collected, detailed neurological examination done at presentation and d- dimer levels were evaluated. Results: Among our study group a male preponderance was noted (60%) in discordance with the global pattern of CVT. Headache was the most common presenting feature and papilledema was noted in 98% of our patients. Additional clinical signs noted at presentation were nausea and vomiting (78%), seizures (28%), limb weakness (24%) and alteration in sensorium at presentation (14%). Risk factors were alcohol dependency (36%), postpartum period (12%) and anaemia (12%). Additionally the sensitivity of D-dimer was noted to be 90.74% with a specificity of 100% in predicting the disease. Conclusion: Our study differs from the global pattern of CVT in terms of male preponderance, higher detection of papilledema, lesser occurrence of anaemia, and a large proportion of patients with d-dimer positivity. The limitation of the study is the sample size as we cannot extrapolate our results to the population at large. However our data is in concordance with the current concept of CVT, that diagnosis is the key challenge in management.