Sensitivity of Serum D-dimer for Spontaneous Subarachnoid Hemorrhage.
Subarachnoid hemorrhage activates the fibrinolytic system and increases serum D-dimer levels. These levels could prove diagnostically useful if reliably elevated in patients with SAH. Our goal was to calculate the sensitivity of serum D-dimer in detecting spontaneous subarachnoid hemorrhage.
We reviewed case records of all patients diagnosed with spontaneous SAH at our institution from 1990-2012. We excluded patients who had SAH from traumatic injuries, known intracranial pathology, as well
as those having intracerebral hemorrhage. We recorded whether the D-dimer level was assessed in each patient, as well as the timing of the D-dimer measurement
Headache accounts for 2% of Emergency Department visits, and subarachnoid hemorrhage accounts for 1-3% of these headaches. It is infrequent, yet deadly, with a case fatality rate reported as high as 40-50%. It can be difficult to diagnose, as neurologically intact patients presenting with only headache can account for half of all SAH at initial presentation.
The current diagnostic gold standard is high-resolution computerized tomography scanning, followed by lumbar puncture in patients with negative imaging. The requirement for lumbar puncture is not ideal. It is often troublesome to patients, can be technically difficult and cumbersome, and can be fraught with complications including postural headache, nerve injury, epidural hematoma and both local tissue and CSF infections.
Furthermore, the cerebrospinal fluid red-blood-cell cut-off for the diagnosis remains unclear, and a traumatic
puncture can lead to further uncertainty. A more streamlined approach to quickly diagnosing SAH would be welcome.
Emerg Med Open J. 2016; 3(1): 6-10. doi: 10.17140/EMOJ-3-131
