Department of Neurology, Faculty of Medical Sciences, Medical University of Warsaw, Warsaw, Poland, Cegłowska 80, 01-809 Warsaw, Poland.
Faculty of Mathematics and Information Science, Warsaw University of Technology, Koszykowa 72 st., 00-662 Warsaw, Poland.
Neurol Neurochir Pol. 2020;54(1):66-72. doi: 10.5603/PJNNS.a2020.0006. Epub 2020 Jan 22.
We investigated whether D-dimer (DD) concentration is elevated in cerebral venous and sinus thrombosis (CVST), as has been reported in the literature.
CVST is a disease with variable clinical presentations and a challenging diagnosis. We looked into whether D-dimer concentration might be an indicator of CVST, and the need for neuroimaging tests correlated with clinical factors.
We included all consecutive patients (mean age 41.6 years) with CVST treated in our neurology department from 2014 to 2018 whose DD levels had been measured. DD concentrations were categorised as normal (≤ 0.5 μg/ml) or elevated ( > 0.5 μg/ml). Appropriate imaging confirmed the diagnosis of CVST. The results were compared to those of a control group consisting of 22 age- and sex-matched patients (mean age 40 years) with a diagnosis of primary headache (tension type or migraine) hospitalised to exclude secondary causes.
In 20 patients in the CVST study group, median level of DD was 1.0 + 0.57 μg/ml (range 0.19-2.45 μg/ml), compared to the control group's mean DD level of 0.50 + 0.45 μg/ml (range 0.15-1.73 μg/ml), with p < 0.005. Higher DD levels were associated with complications of the disease and fatal course (p < 0.005). One female and one male patient died because of CVST with DD levels of (respectively) 2.45 and 1.80 μg/ml - the two highest concentrations in our study group.
DD concentration, especially in headache patients, may be a factor to predict CVST and an indicator for further diagnostic procedures with venography. But in clinical practice, low levels of DD cannot be taken to exclude CVST.
我们研究了 D-二聚体（DD）浓度是否在脑静脉和窦血栓形成（CVST）中升高，正如文献中所报道的那样。
CVST 是一种临床表现多样且诊断具有挑战性的疾病。我们研究了 D-二聚体浓度是否可能是 CVST 的一个指标，以及神经影像学检查的必要性与临床因素的相关性。
我们纳入了 2014 年至 2018 年在我院神经内科治疗的所有连续的 CVST 患者（平均年龄 41.6 岁），并对其 DD 水平进行了测量。DD 浓度分为正常（≤0.5μg/ml）或升高（>0.5μg/ml）。适当的影像学检查确认了 CVST 的诊断。将结果与由 22 名年龄和性别匹配的原发性头痛（紧张型或偏头痛）患者（平均年龄 40 岁）的对照组进行比较，这些患者住院是为了排除继发性原因。
在 CVST 研究组的 20 名患者中，中位数的 DD 水平为 1.0 + 0.57μg/ml（范围 0.19-2.45μg/ml），而对照组的平均 DD 水平为 0.50 + 0.45μg/ml（范围 0.15-1.73μg/ml），p <0.005。较高的 DD 水平与疾病的并发症和致命病程相关（p <0.005）。一名女性和一名男性患者因 CVST 死亡，其 DD 水平分别为（分别）2.45 和 1.80μg/ml-这是我们研究组中最高的两个浓度。
DD 浓度，特别是在头痛患者中，可能是预测 CVST 的一个因素，也是进一步进行静脉造影诊断程序的一个指标。但在临床实践中，DD 水平低不能用来排除 CVST。
