Extracranial and intracranial arterial stenoocclusive disease in acute ischemic stroke patients: A study from north India - Evaluation with MR angiography

Abstract

Introduction: Early diagnosis of cerebral venous sinus thrombosis (CVT) is essential because early treatment may prevent morbidity and may even be life-saving. Definite exclusion, however, needs advanced neuroradiologic diagnostics, which are not readily available in many hospitals. A biological marker like D-dimer can be used as a tool to help in diagnosis of CVT. Aims: To evaluate patients with CVT with diverse clinical manifestations and assess the importance of D-dimer in the diagnosis. Settings and Design: Prospective observational study carried out at Dept. of Neurology at a tertiary care hospital. Methods and Material: A total of 56 patients with CVT were subjected to a detailed medical history and neurological evaluation. A MRI brain was carried out on a 1.5T scanner using T1, T2, and Diffusion weighted sequences and TOF MR venography. D-dimer was quantitatively estimated by immunoturbidimetry. Statistical analysis used: SPSS 19 statistical software was used. Unpaired t test, ANOVA, Pearson chi square test was used to analyse different parameters. Significance level of 95% with p<0.05 was considered statistically significant. Results: A total 56 patients were enrolled in this study. The mean age was 33.98 +/-13.20 years. Female: male ratio was 2.3:1. Headache was the most common presentation (82.1%) followed by vomiting(48.2%). MRI brain showed infarct in 39(69.6%) patients, out of which 24 (42.8%) had hemorrhagic venous infarct. Most common sinus involved was superior saggital sinus (71.4%) followed by transverse (64.3%). Mean D-dimer concentration in patients with 1 vein involvement was 1.04, in 2 vein involvement it was 1.35, in 3 vein involvement it was 1.30, 1.96 in patients with 4 and 5.67 in patients with more than 6 vein involvement which was found to be significant statistically. Conclusions: D-dimer might be not only suitable in the context of diagnosing CVT but also may be helpful in estimating severity of disease.