Cerebral venous sinus thrombosis laboratory findings: Difference between revisions
Created page with "__NOTOC__ {{cerebral venous sinus thrombosis}} {{CMG}} ==Laboratory Findings== The diagnosis may be suspected on the basis of the symptoms (e.g. the combination of headache, ..." |
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A 2004 German study suggested that the [[D-dimer]] blood test, already in use for the diagnosis of other forms of thrombosis, was abnormal (above 500 μg/l) in 34 out of 35 patients with cerebral sinus thrombosis, giving it a [[sensitivity (test)|sensitivity]] of 97.1%, a [[negative predictive value]] of 99.6%, a [[specificity]] of 91.2%, and a positive predictive value of 55.7%. Furthermore, the level of the D-dimer correlated with the extent of the thrombosis.<ref>{{cite journal |author=Kosinski CM, Mull M, Schwarz M, ''et al'' |title=Do normal D-dimer levels reliably exclude cerebral sinus thrombosis? |journal=Stroke |volume=35 |issue=12 |pages=2820–5 |year=2004 |pmid=15514174 |doi=10.1161/01.STR.0000147045.71923.18}}</ref> A subsequent 2005 study performed in France showed that 10% of patients with confirmed thrombosis had a normal D-dimer, and in those who had presented with only a headache 26% had a normal D-dimer. The study concludes that D-dimer is not useful in the situations where it would make the most difference (low-probability settings).<ref>{{cite journal |author=Crassard I, Soria C, Tzourio C, ''et al'' |title=A negative D-dimer assay does not rule out cerebral venous thrombosis: a series of seventy-three patients |journal=Stroke |volume=36 |issue=8 |pages=1716–9 |year=2005 |pmid=16020765 |doi=10.1161/01.STR.0000173401.76085.98}}</ref> | A 2004 German study suggested that the [[D-dimer]] blood test, already in use for the diagnosis of other forms of thrombosis, was abnormal (above 500 μg/l) in 34 out of 35 patients with cerebral sinus thrombosis, giving it a [[sensitivity (test)|sensitivity]] of 97.1%, a [[negative predictive value]] of 99.6%, a [[specificity]] of 91.2%, and a positive predictive value of 55.7%. Furthermore, the level of the D-dimer correlated with the extent of the thrombosis.<ref>{{cite journal |author=Kosinski CM, Mull M, Schwarz M, ''et al'' |title=Do normal D-dimer levels reliably exclude cerebral sinus thrombosis? |journal=Stroke |volume=35 |issue=12 |pages=2820–5 |year=2004 |pmid=15514174 |doi=10.1161/01.STR.0000147045.71923.18}}</ref> A subsequent 2005 study performed in France showed that 10% of patients with confirmed thrombosis had a normal D-dimer, and in those who had presented with only a headache 26% had a normal D-dimer. The study concludes that D-dimer is not useful in the situations where it would make the most difference (low-probability settings).<ref>{{cite journal |author=Crassard I, Soria C, Tzourio C, ''et al'' |title=A negative D-dimer assay does not rule out cerebral venous thrombosis: a series of seventy-three patients |journal=Stroke |volume=36 |issue=8 |pages=1716–9 |year=2005 |pmid=16020765 |doi=10.1161/01.STR.0000173401.76085.98}}</ref> | ||
===Further | ===Further Tests=== | ||
In most patients, the direct cause for the cerebral sinus thrombosis is not readily apparent. Identifying a source of infection is crucial, but it is common practice to screen for various forms of [[thrombophilia]] (a propensity to form blood clots).<ref name=Stam2005/> | In most patients, the direct cause for the cerebral sinus thrombosis is not readily apparent. Identifying a source of infection is crucial, but it is common practice to screen for various forms of [[thrombophilia]] (a propensity to form blood clots).<ref name=Stam2005/> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Laboratory Findings
The diagnosis may be suspected on the basis of the symptoms (e.g. the combination of headache, signs of raised intracranial pressure and focal neurological abnormalities), or when alternative causes of headache and neurological abnormalities (such as a subarachnoid hemorrhage) have been excluded.[1]
D-Dimer
A 2004 German study suggested that the D-dimer blood test, already in use for the diagnosis of other forms of thrombosis, was abnormal (above 500 μg/l) in 34 out of 35 patients with cerebral sinus thrombosis, giving it a sensitivity of 97.1%, a negative predictive value of 99.6%, a specificity of 91.2%, and a positive predictive value of 55.7%. Furthermore, the level of the D-dimer correlated with the extent of the thrombosis.[2] A subsequent 2005 study performed in France showed that 10% of patients with confirmed thrombosis had a normal D-dimer, and in those who had presented with only a headache 26% had a normal D-dimer. The study concludes that D-dimer is not useful in the situations where it would make the most difference (low-probability settings).[3]
Further Tests
In most patients, the direct cause for the cerebral sinus thrombosis is not readily apparent. Identifying a source of infection is crucial, but it is common practice to screen for various forms of thrombophilia (a propensity to form blood clots).[1]
References
- ↑ 1.0 1.1 Stam J (2005). "Thrombosis of the cerebral veins and sinuses". N. Engl. J. Med. 352 (17): 1791–8. doi:10.1056/NEJMra042354. PMID 15858188.
- ↑ Kosinski CM, Mull M, Schwarz M; et al. (2004). "Do normal D-dimer levels reliably exclude cerebral sinus thrombosis?". Stroke. 35 (12): 2820–5. doi:10.1161/01.STR.0000147045.71923.18. PMID 15514174.
- ↑ Crassard I, Soria C, Tzourio C; et al. (2005). "A negative D-dimer assay does not rule out cerebral venous thrombosis: a series of seventy-three patients". Stroke. 36 (8): 1716–9. doi:10.1161/01.STR.0000173401.76085.98. PMID 16020765.