Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2015

Open Access 01-12-2015 | Research article

D-dimer for the exclusion of cerebral venous thrombosis: a meta-analysis of low risk patients with isolated headache

Authors: Imanda M.E. Alons, Korné Jellema, Marieke J.H. Wermer, Ale Algra

Published in: BMC Neurology | Issue 1/2015

Login to get access

Abstract

Background

Patients with isolated headache may have cerebral venous thrombosis (CVT). D-dimers are proven sensitive in excluding deep venous thrombosis (DVT) and pulmonary embolism (PE) in low risk patients. We aimed to determine whether D-dimer may play the same role in low risk CVT patients with isolated headache.

Methods

We included consecutive patients suspected of CVT from our teaching hospital with isolated headache, a normal neurological examination and normal standard head CT in whom D-dimer was determined. Additionally we did a systematic review on articles describing consecutive patients suspected of CVT with isolated headache and their D-dimer values. CVT was investigated with CT or MR venography in all patients.

Results

A total of 636 consecutive patients were collected from our own data and the literature search. Of 45 CVT patients one had a negative D-dimer (7.5 %). Sensitivity of D-dimer for diagnosing CVT was 97.8 % (95 % CI: 88.2–99.6 %), specificity was 84.9 % (95 % CI: 81.8–87.7 %), positive predictive value was 33.1 % (95 % CI: 25.2–41.7 %), negative predictive value was 99.8 % (95 % CI: 98.9–100 %). Another 56 isolated headache CVT patients were identified in literature, lacking consecutive isolated headache controls. Sensitivity of D-dimer for diagnosing CVT including these patients was 87.1 % (95 % CI: 79.0–93.0 %).

Conclusions

D-dimers have a high negative predictive value in patients with isolated headache for excluding CVT. Sensitivity is lower but comparable to the values accepted in PE and DVT. Low risk patients were defined as headache patients with a normal neurological examination, normal standard head CT and absence of risk factors such as pregnancy or puerperium. Normal D-dimers in these patients may reduce unnecessary imaging, making it a potential valuable marker.
Literature
1.
Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F, Investigators ISCVT. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004;35:664–70.CrossRefPubMed
2.
Ferro JM, Canhão P, Bousser MG, Stam J, Barinagarrementeria F, Investigators ISCVT. Early seizures in cerebral vein and dural sinus thrombosis: risk factors and role of antiepileptics. Stroke. 2008;39:1152–8.CrossRefPubMed
3.
Cumurciuc R, Crassard I, Sarov M, Valade D, Bousser MG. Headache as the only neurological sign of cerebral venous thrombosis: a series of 17 cases. Journal Neurol Neurosurg Psychiatry. 2005;76:1084–7.CrossRef
4.
de Bruijn SF, Stam J, Kappelle. Thunderclap headache as first symptom of cerebral venous sinus thrombosis. CVST Study Group. Lancet. 1996;348(9042):1623–5.CrossRefPubMed
5.
Biousse V, Ameri A, Bousser MG. Isolated intracranial hypertension as the only sign of cerebral venous thrombosis. Neurology. 1999;53:1537–42. 22.CrossRefPubMed
6.
Gameiro J, Ferro JM, Canhão P, Stam J, Barinagarrementeria F, Lindgren A. Prognosis of cerebral vein thrombosis presenting as isolated headache: early vs. late diagnosis.; International Study on Cerebral Vein and Dural Sinus Thrombosis investigators. Cephalalgia. 2012;32:407–12.CrossRefPubMed
7.
8.
9.
Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, et al. Investigators Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators. Am J Med. 2006;119:1048.CrossRefPubMed
10.
Di Nisio M, Squizzato A, Rutjes AW, Büller HR, Zwinderman AH, Bossuyt PM. Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review. J Thromb Haemost. 2007;2:296–304.CrossRef
11.
Dentali F, Squizzato A, Marchesi C, Bonzini M, Ferro JM, Ageno W. D-dimer testing in the diagnosis of cerebral vein thrombosis: a systematic review and a meta-analysis of the literature. J Thromb Haemost. 2012;10:582–9.CrossRefPubMed
12.
Saposnik G, Barinagarrementeria F, Brown Jr RD, Bushnell CD, Cucchiara B, Cushman M, et al. American Heart Association Stroke Council and the Council on Epidemiology and Prevention. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:1158–92.CrossRefPubMed
13.
Crassard I, Soria C, Tzourio C, Woimant F, Drouet L, Ducros A, et al. A negative D-dimer assay does not rule out cerebral venous thrombosis: a series of seventy-three patients. Stroke. 2005;36:1716–19.CrossRefPubMed
14.
Kosinski CM, Mull M, Schwarz M, Koch B, Biniek R, Schlafer J, et al. Do normal D-dimer levels reliably exclude cerebral sinus thrombosis? Stroke. 2004;35:2820–5.CrossRefPubMed
15.
Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529–36. 18.CrossRefPubMed
16.
Tardy B, Tardy-Poncet B, Viallon A, Piot M, Garnier P, Mohamedi R, et al. D-dimer levels in patients with suspected acute cerebral venous thrombosis. Am J Med. 2002;113:238–41. 15.CrossRefPubMed
17.
Meng R, Wang X, Hussain M, Dornbos 3rd D, Meng L, Liu Y, et al. Evaluation of plasma D-dimer plus fibrinogen in predicting acute CVST. Int J Stroke. 2014;9:166–73.CrossRefPubMed
18.
Misra UK, Kalita J, Bansal V. D-dimer is useful in the diagnosis of cortical venous sinus thrombosis. Neurol India. 2009;57:50–4.CrossRefPubMed
19.
Hiltunen S, Putaala J, Haapaniemi E, Salonen O, Tatlisumak T. D-dimer and clinicoradiologic features in cerebral venous thrombosis. J Neurol Sci. 2013;15(327):12–4.CrossRef
20.
Lalive PH, de Moerloose P, Lovblad K, Sarasin FP, Mermillod B, Sztajzel R. Is measurement of D-dimer useful in the diagnosis of cerebral venous thrombosis? Neurology. 2003;61:1057–60.CrossRefPubMed
21.
Gouda T, Sabry M. Evaluation of Plasma D-Dimer Assay as A Diagnostic Biomarker for Cerebral Venous Thrombosis. Egypt J Neurol Psychiat Neurosurg. 2010;47:331–6.
22.
Cucchiara B, Messe S, Taylor R, Clarke J, Pollak E. Utility of D-dimer in the diagnosis of cerebral venous sinus thrombosis. J Thromb Haemost. 2005;3:387–9.CrossRefPubMed
23.
Tanislav C, Siekmann R, Sieweke N, Allendörfer J, Pabst W, Kaps M, et al. Cerebral vein thrombosis: clinical manifestation and diagnosis. BMC Neurol. 2011;11:69. 10.CrossRefPubMedPubMedCentral
24.
Ghaffarpour M, Mohsenzadeh N, Poormahmoodian H, Harrirchian M, Fallah A. Diagnostic value of D-dimer measurement in patients suspected of having cerebral venous thrombosis. Acta Med Iran. 2008;46:481–4.
Metadata
Title
D-dimer for the exclusion of cerebral venous thrombosis: a meta-analysis of low risk patients with isolated headache
Authors
Imanda M.E. Alons
Korné Jellema
Marieke J.H. Wermer
Ale Algra
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2015
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-015-0389-y

Other articles of this Issue 1/2015

BMC Neurology 1/2015 Go to the issue

Research article

Factors associated with seizure occurrence and long-term seizure control in pediatric brain arteriovenous malformation: a retrospective analysis of 89 patients

Study protocol

The ThRombolysis in UnconTrolled Hypertension (TRUTH) protocol: an observational study on treatment strategy of elevated blood pressure in stroke patients eligible for IVT

Research article

Transient spurious intrathecal immunoglobulin synthesis in neurological patients after therapeutic apheresis

Research article

Using antidepressants and the risk of stroke recurrence: report from a national representative cohort study

Research article

Disparate voxel based morphometry (VBM) results between SPM and FSL softwares in ALS patients with frontotemporal dementia: which VBM results to consider?

Case report

Good’s syndrome with opportunistic infection of the central nervous system: a case report