Abstract

Thrombosis of the venous channels in the brain accounts for 0·5% of all stroke and is an uncommon cause of cerebral infarction relative to arterial disease but is an important consideration because of its potential morbidity¹ The aim of this study is to evaluate the D-Dimer as a screening tool for the diagnosis of cerebral venous thrombosis.

Aims and Objectives: To study the clinical characteristics, risk factors and outcome of cerebral venous thrombosis. To evaluate the role of D-Dimer in the diagnosis of cerebral venous thrombosis. To find co-relation if any between levels of D-Dimer, duration of symptoms and outcome of cerebral venous thrombosis.

Discussion

Epidemiology of Cerebral Venous Thromsosis

Age and Sex: In the present study the average age of presentation for patients with cerebral venous thrombosis was 29.79+SD 12.1414 years. The youngest patient was of 14 years while the oldest was of 63 years.

Clinical Features: In the present study headache was the most common symptom seen in 91.6% of all patients. Other symptoms include seizures (79%), focal nuerological deficit (50%), diffuse encephalopathy (29.1%), fever (29.1%), and dimunition of vision (8.3%).

Outcome: In the 24 patients evaluated in our study, 17 (70.83%) patients had complete recovery in 1 month whereas 5 (20.83%) had persistent deficit at the end of 1 month. Complete recovery at one month was seen in  80% of male patients and 78.95% in female patients. The mortality rate in our study of CVT was found to be 8.33%. Factors associated with increased mortality were presence of sepsis and seizures.

D-Dimer levels in cerebral venous thrombosis: In the present study the D-Dimer levels were found to be elevated in 22 out of the 24 patients evaluated. The mean value of D-Dimer for patients with cerebral venous thrombosis was found to be 1.815417 + SD 1.498352 mcg/ml and that of controls was found to be 0.41433 + SD 0.234403 mcg/ml. The difference between the values of cases and controls was found to be statistically significant with ‘p’ value < 0.001. Mean (cases)- Mean (controls) = 1.401054 with 95% confidence interval between 0.84 to 1.95708.

Summary & Conclusions: The present study evaluated 24 patients of Cerebral Venous Thrombosis and 30 age and sex matched controls. The risk factors, clinical presentations, and duration of symptoms of both the groups were determined. The level of D-dimer were determined for both cases and controls and its significance was tested by statistical analysis.

The mean age for cases of CVT in the present study was 29.79 years.

Females accounted for 79.16 % of cases and were affected at a younger age in comparision with males. The male: female ratio in the study was 1:3.8.

Average duration of symptoms before presentation in the present study was 5.67 + SD 4.26 days.

Headache and seizures were the most common clinical features of CVT.

In the present study, puerperium was the most common risk factor for the development of CVT.

D-Dimer levels were significantly elevated in patients of CVT as compared with controls (p< 0.001).

D-Dimer assay was found to have high sensitivity (91.66 %) in predicting the presence of CVT in the present study. The specificity, positive predictive value and negative predictive value of D-Dimer levels was found to be 80 %, 78.59% and 92.30 % respectively.

In the present study the sensitivity of D-dimer assay was highest when the test was applied early in the course of illness (100 %). The sensitivity of the test declined rapidly as the duration of symptoms prior to testing increased.

The present study supports the use of D-dimer as a ‘rule out’ test for CVT. The diagnosis of CVT is unlikely in the presence of a normal D-Dimer value. Patients with features of CVT with elevated D-Dimer should be urgently sent for MRV for confirmation of diagnosis. However the elevation of D-Dimer itself does not indicate presence of CVT. 

Keywords -cerebral venous thrombosis, D-dimer.