From the Research
D-dimer would typically be elevated in cerebral thrombosis, but its elevation is not specific to this condition and requires correlation with clinical symptoms and additional diagnostic imaging for confirmation. D-dimer is a fibrin degradation product that increases when there is clot formation and subsequent breakdown in the body. In cerebral thrombosis, which involves blood clot formation in the brain's blood vessels, the body's natural clot dissolution process releases d-dimer into the bloodstream. However, it's essential to note that while d-dimer elevation is sensitive for thrombotic events, it is not specific to cerebral thrombosis alone. Elevated d-dimer levels can occur in various conditions, including deep vein thrombosis, pulmonary embolism, disseminated intravascular coagulation, recent surgery, pregnancy, infection, and malignancy 1.
Key Points to Consider
- The clinical presentation of cerebral venous thrombosis is diverse, requiring a high level of clinical suspicion 1.
- Imaging studies such as computed tomography (CT) venography or magnetic resonance (MR) venography should be obtained in patients with concern for CVT, as non-contrast CT will be normal or have non-specific findings in most patients 2.
- Treatment includes anticoagulation, treating seizures and elevated ICP aggressively, and neurosurgical or interventional radiology consultation in select cases 2.
- D-dimer measurements are of limited clinical value because of false positive and negative results 3.
Diagnostic Approach
The diagnosis of cerebral thrombosis should be based on a combination of clinical symptoms, imaging studies, and laboratory tests, including d-dimer levels. A normal d-dimer can help rule out cerebral thrombosis (high negative predictive value), but an elevated level requires correlation with clinical symptoms and additional diagnostic imaging such as CT or MRI to confirm the diagnosis of cerebral thrombosis 4, 3.
Management
The management of cerebral thrombosis involves anticoagulation, treating seizures and elevated ICP aggressively, and neurosurgical or interventional radiology consultation in select cases 1, 2. The presence of cerebral venous congestion in patients with dural sinus thrombosis, even while on anticoagulation therapy, appears to be an indication for thrombectomy and infusion of thrombolytic agent through a balloon catheter to the site of thrombosis 5.