1. Cerebral infarcts and vasculopathy in Tanzanian children with sickle cell anemia
- Author
-
Fenella J. Kirkham, Frank Kussaga, Dawn E. Saunders, Bruno Mmbando, Julie Makani, Mboka Jacob, Jamie M. Kawadler, A Slee, Magda Ahmed, Hilda Tutuba, Raphael Z. Sangeda, and Balowa Musa
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Ultrasonography, Doppler, Transcranial ,Anemia ,Anemia, Sickle Cell ,Comorbidity ,Tanzania ,Asymptomatic ,Magnetic resonance angiography ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Developmental Neuroscience ,030225 pediatrics ,Internal medicine ,Prevalence ,medicine ,Humans ,Child ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Cerebral Infarction ,Hypoxia (medical) ,medicine.disease ,Magnetic Resonance Imaging ,Sickle cell anemia ,Transcranial Doppler ,Cerebrovascular Disorders ,Cross-Sectional Studies ,Neurology ,Cerebral blood flow ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Cardiology ,Female ,Neurology (clinical) ,medicine.symptom ,business ,Magnetic Resonance Angiography ,030217 neurology & neurosurgery - Abstract
Background: Cerebral infarcts and vasculopathy in neurologically asymptomatic children with sickle cell anemia (SCA) have received little attention in African settings. This study aimed to establish the prevalence of silent cerebral infarcts (SCI) and vasculopathy and determine associations with exposure to chronic hemolysis, anemia, and hypoxia.Methods: We prospectively studied 224 children with SCA with transcranial Doppler (TCD), and magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). Regressions were undertaken with contemporaneous hemoglobin, reticulocyte count, mean prior hemoglobin, oxygen content, reticulocyte count, and indirect bilirubin.Results: Prevalence of SCI was 27% (61 of 224); cerebral blood flow velocity was abnormal (>200 cm/s) in three and conditional (>170Conclusions: SCI and vasculopathy on MRA are common in neurologically asymptomatic children with SCA living in Africa, even when TCD is normal. Children with vasculopathy on MRA are at increased risk of SCI. Longitudinal exposure to anemia, hypoxia, and hemolysis appear to be risk factors for vasculopathy.
- Published
- 2019