A Study on Evaluation of Plasma D-Dimer as an Initial Diagnostic Biomarker in Cerebral Venous Thrombosis

BACKGROUND : Cerebral venous thrombosis (CVT) is a life threatening condition with varied clinical presentations. It is mainly a diagnosis by means of radiological tool. CT Brain is the initial investigation of choice. It may be normal in 30–40% of the population. MRI with MRV is the gold standard for the diagnosis of CVT. D Dimer is a product of fibrinolysis which is usually used as an exclusion marker of venous thrombosis. Our study aims to analyse the usefulness of D Dimer as an initial diagnostic marker in CVT. OBJECTIVES: 1. To estimate the level of plasma D-DIMER and its significance in diagnosing Cerebral Venous Thrombosis. 2. To correlate the relationship between plasma D-DIMER and MRI BRAIN in diagnosing Cerebral Venous Thrombosis. 3. To evaluate the diagnostic value of negative D-DIMER in ruling out Cerebral Venous Thrombosis. METHODOLOGY : The patients diagnosed to have CVT by MRI in Coimbatore Medical College above 18 yrs of age are included in the study. A total of 50 patients are included in the study. After confirming the diagnosis, blood samples were drawn, plasma separated and sent to laboratory. D Dimer tests were measured by ELISA test. A value of more than 500 ng/ml were considered positive. All the tests were entered in a data collection sheet in an Excel format and analysed using SPSS software. RESULTS : Out of the 50 patients, 28 were females, and 28 were above 35 yrs. The common presenting symptom is headache (96%), followed by seizures, altered sensorium, with papilledema (60%). The most common sinus involved is superior sagittal sinus (70%) followed by sigmoid and transverse sinus. CT Brain was normal in 50% of the patients. Inherited thrombophilias contribute to 23%. D Dimer was positive in 78% of the study population. D Dimer and MRV has a highly significant correlation (0.034). D Dimer and onset of symptoms have a very high significant value of 0.000. CONCLUSION : D Dimer can be used as an initial diagnostic bio marker in CVT as there is a significant association with MRI. If patients present very early D Dimer is a highly reliable investigation. Further studies needed for the supportive evidence