This Article Full Text Full Text (PDF) All Versions of this Article: 35/12/2820    most recent 01.STR.0000147045.71923.18v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kosinski, C. M. Articles by Schiefer, J. Search for Related Content PubMed PubMed Citation Articles by Kosinski, C. M. Articles by Schiefer, J. Related Collections Cerebrovascular disease/stroke Deep vein thrombosis CT and MRI Cerebral Venous Thrombosis Angiography Computerized tomography and Magnetic Resonance Imaging

(Stroke. 2004;35:2820.)
© 2004 American Heart Association, Inc.

Original Contributions

Do Normal D-dimer Levels Reliably Exclude Cerebral Sinus Thrombosis?

Christoph M. Kosinski, MD; Michael Mull, MD; Michael Schwarz, MD; Benno Koch, MD; Rolf Biniek, MD; Joachim Schläfer, MD; Eva Milkereit; Klaus Willmes, PhD Johannes Schiefer, MD

From the Departments of Neurology (C.M.K., E.M., J.S.), Neuroradiology (M.M.), and Neuropsychology (K.W.), Universitätsklinikum Aachen, Germany; the Department of Neurology (M.S., B.K.), Klinikum Dortmund, Germany; and the Department of Neurology (R.B., J.S.), Rheinische Kliniken Bonn, Germany.

Correspondence to Dr Christoph M. Kosinski, Department of Neurology, Universitätsklinikum Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany. E-mail CKosinski{at}ukaachen.de

Background and Purpose— Cerebral sinus thrombosis (CST) needs to be considered in the differential diagnosis of all patients with acute headache. Early diagnosis is essential because early treatment may prevent morbidity and may even be life-saving. Definite exclusion, however, needs advanced neuroradiologic diagnostics, which are not readily available in many hospitals. Because measurement of D-dimers has been demonstrated to be helpful in excluding thromboembolic disease, our aim was to investigate whether D-dimers would be also sensitive enough to exclude CST.

Methods— We undertook a prospective multicenter study over a 2.5-year period including all patients who came to the emergency departments with symptoms suggestive of CST. All patients were diagnosed either by magnetic resonance venography, spiral computed tomography scan venography, or intra-arterial digital subtraction angiography. D-dimer levels were measured at admission and analyzed by the same method in all patients.

Results— A total of 343 patients were included. CST was diagnosed in 35 patients, of whom 34 had D-dimers above the cutoff value (>500 µg/L). From the 308 patients not having CST, D-dimers were elevated in 27. Sensitivity of D-dimers was 97.1%, with a negative predictive value of 99.6%. Specificity was 91.2%, with a positive predictive value of 55.7%. D-dimers were positively correlated with the extent of the thrombosis and negatively correlated with the duration of symptoms (Spearman rank correlation coefficients 0.76, –0.58, respectively).

Conclusions— D-dimer measurement is useful in patients with suspected CST. Normal D-dimers make the presence of CST very unlikely.

Key Words: cerebrovascular disorders • computerized tomography • magnetic resonance imaging • thromboembolism

This article has been cited by other articles:

				B. Vatankhah, A. Furst, F. Schlachetzki, and C. M. Kosinski Do Normal D-Dimer Levels Reliably Exclude Cerebral Sinus Thrombosis? A Solution of Problems? * Response: Stroke, December 1, 2005; 36(12): 2528 - 2529. [Full Text] [PDF]

				I. Crassard, C. Soria, C. Tzourio, F. Woimant, L. Drouet, A. Ducros, and M.-G. Bousser A Negative D-Dimer Assay Does Not Rule Out Cerebral Venous Thrombosis: A Series of Seventy-Three Patients Stroke, August 1, 2005; 36(8): 1716 - 1719. [Abstract] [Full Text] [PDF]