The role of D-dimer in diagnosis of cerebral sinus venous thrombosis

Cerebral sinus venous thrombosis (CSVT) is a fatal condition and should be considered in all patients with acute new onset headache. D-dimer has been shown to be a sensitive diagnostic tool in deep vein thrombosis and pulmonary thromboembolism. The purpose of this study was to investigate whether this test could be useful in the diagnosis of CSVT.

In this prospective study, we reviewed patients referring to Nemazee hospital with presentations suggestive of CSVT. Diagnosis was established, using MRI and MRV. Serum D-dimer level was checked among 24 hours after hospital admission.

From 117 enrolled patients, 37 (31.6%) patients had CSVT. The reported D-dimer levels showed negative (< 500 ng/ml) in 21 (56.76%) and positive level in 16 (43.24 %) patients who had CSVT. Also, D-dimer was negative in 66 (82.5%) and positive in 14 (17.5%) patients who did not have CSVT. These results demonstrated a sensitivity of 43.24%, specificity of 82.5%, positive predictive value of 53.3%, and negative predictive value of 75.86%.

Our study suggests that D-dimer test may guide us to approach patients who are suspectedwith CSVT in emergency situations with limited access to MRI/MRV, although every patient with highD-dimer level and clinical suspicion of CSVT should undergo specific brain imagines.Inaddition, our results showed a negative D-dimer test was not a reliable assay to completely rule out CSVT. However, we recommend further studies to confirm our results.