title: Cerebral vein thrombosis: clinical manifestation and diagnosis.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, Justus Liebig University, Giessen, Germany. Christian.Tanislav@neuro.med.uni-giessen.de
authors.forename: Christian
authors.initials: C
authors.lastname: Tanislav
authors.forename: Ralf
authors.initials: R
authors.lastname: Siekmann
authors.forename: Nicole
authors.initials: N
authors.lastname: Sieweke
authors.forename: Jens
authors.initials: J
authors.lastname: Allendörfer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Pabst
authors.forename: Manfred
authors.initials: M
authors.lastname: Kaps
authors.forename: Erwin
authors.initials: E
authors.lastname: Stolz
mesh_terms: D000328:Adult; D019540:Area Under Curve; D002533:Cerebral Angiography; D002550:Cerebral Veins / Q000473:pathology*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D020767:Intracranial Thrombosis / Q000097:blood / Q000175:diagnosis*; D008297:Male; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D