ROLE OF D-DIMER IN DIAGNOSIS OF ACUTE CEREBRAL VENOUS THROMBOSIS

Abstract

Background: Cerebral venous thrombosis (CVT) is a long-term debilitating vascular brain disease with high morbidity and mortality. Plasma levels of D-dimer are shown to be elevated and sensitive for the diagnosis of cerebral venous thrombosis (CVT). Objective: To evaluate the usefulness of plasma D-dimer levels in diagnosis of cerebral venous thrombosis. Patients and methods: This case-control study was conducted on two groups, patient group (40 patients) with CVT, and control group (10 patients) without CVT. All patients were subjected to full history and complete general and neurological examination focusing on headache either isolated or with symptoms of increased intracranial pressure (nausea/vomiting, papilledema, visual disturbance, disturbance of consciousness), focal motor deficit, cranial nerve palsy, or seizure. Fundus examination was done to detect papilledema and brain MRI and MRV to detect CVT, and determine the affected sinus. D-dimer levels were measured by the rapid sensitive D-dimer assay. The study was done at Department of Neurology, Al-Hussein and SayedGalalUniversityHospitals, Cairo, Egypt. Results: Among patient group, 30 (75%) patients were females, while 10 (25%) patients were males, and the mean of age was 27.4 years. The common presenting symptom was headache with blurred vision in 21 (52.5%) patients, followed by focal seizures in 10 (25%) patients. The most common sinus involved was right (Rt.) transverse sinus in 14 (35%) patients. Twenty-seven (67.5 %) patients had papilledema. D-dimer test was positive in 39 (97.5%) patients in patient group, while in the control group 1 patient (10%) was positive and 9 patients (90%) were negative. Conclusion: Raised D-dimer level was often helpful for early diagnosis of CVT and an important screening tool to determine the early need of neuroimaging in patients who were suspected to have CVT. Negative D-dimer test did not exclude CVT, but indicated that acute CVT was very unlikely.