Cerebral vein thrombosis: clinical manifestation and diagnosis

BMC Neurol. 2011 Jun 10;11:69. doi: 10.1186/1471-2377-11-69.

Abstract

Background: Cerebral venous thrombosis (CVT) is a disease with a wide spectrum of symptoms and severity. In this study we analysed the predictive value of clinical signs and symptoms and the contribution of D-dimer measurements for diagnosis.

Methods: We evaluated consecutive patients admitted with suspected CVT receiving non-invasive imaging. Symptoms and symptom combination as well as D-dimer levels were evaluated regarding their diagnostic value.

Results: 239 patients were included in this study, 170 (71%) were females. In 39 patients (16%) a CVT was found. For identifying a CVT patients underwent either a venous CT-angiography or MR-angiography or both. No combination of symptoms either alone or together with the D-dimer measurements had a sensitivity and positive predictive value as well as negative predictive value and specificity high enough to serve as red flag. D-dimer testing produced rates of 9% false positive and of 24% false negative results. For D-dimer values a Receiver Operating Characteristic curve (ROC) and the area under the curve (AUC = 0.921; CI: 0.864-0.977) were calculated. An increase of sensitivity above 0.9 results in a relevant decrease in specificity; a sensitivity of 0.9 matches a specificity value of 0.9. This corresponds to a D-dimer cut-off level of 0.16 μg/ml.

Conclusion: Imaging as performed by venous CT-angiography or MR-angiography has a 1 to 2 in 10 chance to detect CVT when typical symptoms are present. D-dimer measurements are of limited clinical value because of false positive and negative results.

MeSH terms

  • Adult
  • Area Under Curve
  • Cerebral Angiography
  • Cerebral Veins / pathology*
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Humans
  • Intracranial Thrombosis / blood
  • Intracranial Thrombosis / diagnosis*
  • Male
  • ROC Curve
  • Retrospective Studies
  • Sensitivity and Specificity
  • Venous Thrombosis / blood
  • Venous Thrombosis / diagnosis*

Substances

  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D