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Acute silent cerebral infarction in children with sickle cell anemia

Michael M Dowling1, Charles T Quinn, Zora R Rogers

  • 1Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-9063, USA. michael.dowling@utsouthwestern.edu

Pediatric Blood & Cancer
|October 9, 2009
PubMed

Insights

Silent cerebral infarctions (SCI) in children with sickle cell anemia are often missed. Acute SCI can be detected using MRI, even with subtle symptoms, and may result from anemia.

Area of Science:

  • Pediatric Neurology
  • Hematology
  • Radiology

Background:

  • Silent cerebral infarctions (SCI) affect up to 35% of children with sickle cell anemia (HbSS).
  • Acute SCI are difficult to identify within the critical 10-14 day window using diffusion-weighted MRI.
  • Recognizing acute SCI is crucial for understanding disease progression and potential interventions.

Purpose of the Study:

  • To investigate the detectability and characteristics of acute silent cerebral infarctions (SCI) in children with sickle cell anemia (HbSS).
  • To explore the association between acute anemic events and the occurrence of SCI.
  • To determine if acute SCI lead to permanent neurological deficits.

Main Methods:

  • Case series reporting on seven children with HbSS and suspected acute SCI.
  • Utilized diffusion-weighted magnetic resonance imaging (MRI) to identify areas of restricted diffusion.
  • Correlated MRI findings with clinical presentation, including neurologic deficits and hematologic status.

Main Results:

  • Seven children with HbSS were identified with acute SCI, characterized by restricted diffusion on MRI.
  • Four of these cases were associated with preceding acute anemic events.
  • No persistent focal neurological deficits were observed in the affected children despite MRI evidence of acute infarction.

Conclusions:

  • Acute silent cerebral infarctions (SCI) in children with sickle cell anemia are detectable via MRI.
  • SCI may present with subtle or absent focal neurological deficits.
  • Acute anemic events appear to be a potential cause of acute SCI, which can lead to permanent neurological injury.

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