title: Impact of Elevated D-Dimer on Diagnosis of Acute Aortic Dissection With Isolated Neurological Symptoms in Ischemic Stroke.
abstract: BACKGROUND
  Plasma D-dimer is known to be a useful clinical marker of thrombogenic status, and D-dimer is used as a diagnostic marker for acute aortic dissection (AAD). Little is known, however, regarding the clinical value of D-dimer for diagnosis of asymptomatic AAD in patients with ischemic stroke. We investigated whether D-dimer could be used for early diagnosis of AAD with isolated neurological symptoms in ischemic stroke patients.
  
  
  RESULTS
  We evaluated a total of 1,236 consecutive patients with symptomatic ischemic stroke without chest or back pain who underwent either head computed tomography or magnetic resonance imaging. D-dimer was measured within 24 h after onset. There were 9 patients with Stanford type A AAD and they had significantly higher D-dimer than the patients without AAD (mean, 46.47±54.48 μg/ml; range, 6.9-167.1 μg/ml vs. 2.33±3.58 μg/ml, 0.3-57.9 μg/ml, P<0.001). When a cut-off of 6.9 μg/ml was adopted for d-dimer on the basis of receiver operating characteristics analysis, the sensitivity and specificity for AAD were 100% and 94.8%, respectively, while the positive and negative predictive values were 14.7% and 100%, respectively.
  
  
  CONCLUSIONS
  D-dimer might be a useful marker for the early diagnosis of AAD with isolated neurological symptoms in ischemic stroke patients. Whole-body contrast-enhanced computed tomography should be performed in ischemic stroke patients who have high D-dimer.
authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Yoshimuta
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokoyama
authors.forename: Toshiya
authors.initials: T
authors.lastname: Okajima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanaka
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagatsuka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Higashi
authors.forename: Kenshi
authors.initials: K
authors.lastname: Hayashi
authors.forename: Masa-aki
authors.initials: MA
authors.lastname: Kawashiri
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamagishi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001019:Aortic Rupture / Q000097:blood* / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000097:blood* / Q000000981:diagnostic imaging; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000097:blood* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D