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Published on: March 14, 2017
Current concepts in the management of stroke in children with sickle cell disease
1Department of Haematology, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, England, UK. serajul@doctors.org.uk
Insights
Stroke is a major risk in children with sickle cell disease (SCD). Early detection using transcranial Doppler ultrasonography and preventative strategies are crucial for reducing stroke complications.
Area of Science:
- Pediatric Neurology
- Hematology
- Vascular Medicine
Background:
- Stroke is a leading cause of morbidity and mortality in children with sickle cell disease (SCD).
- Recent decades show advancements in understanding SCD stroke pathophysiology, risk stratification, and preventative interventions.
- This review focuses on the aetiopathogenesis, types, and risk factors of stroke in pediatric SCD.
Purpose of the Study:
- To review the pathophysiology, risk factors, and types of stroke in children with SCD.
- To emphasize the role of transcranial Doppler (TCD) ultrasonography in identifying at-risk children.
- To analyze primary and secondary stroke prevention strategies in pediatric SCD based on evidence levels.
Main Methods:
- Literature review of published studies on stroke in pediatric SCD.
- Analysis of studies focusing on pathophysiology, risk factors, and prevention.
- Emphasis on transcranial Doppler ultrasonography for risk identification.
- Evaluation of evidence for preventative and therapeutic strategies.
Main Results:
- Significant progress in understanding SCD stroke mechanisms and risk factors.
- Transcranial Doppler ultrasonography is vital for early detection of at-risk children.
- Evidence supports specific preventative and therapeutic strategies for stroke in pediatric SCD.
- The roles of neurologists and neurosurgeons in managing SCD stroke are highlighted.
Conclusions:
- Stroke remains a critical complication of SCD in children, necessitating proactive management.
- Early identification via TCD and timely interventions significantly improve outcomes.
- A multidisciplinary approach involving neurology and neurosurgery is essential for stroke prevention and treatment in pediatric SCD.
Abstract:
Stroke is the most significant complication of sickle cell disease (SCD) in children with the potential for major morbidity and mortality. The recent two decades have witnessed tremendous advancements in understanding the pathophysiology of stroke, risk stratification of children and the role of timely preventative interventions. The aetiopathogenesis, types of stroke and specific risk factors are reviewed here with special emphasis on the role of transcranial Doppler ultrasonogram in the early identification of at-risk children. Published studies on primary and secondary prevention of stroke in children with SCD are analysed with respect to the levels of evidence, in favour of preventative and therapeutic strategies. The roles of the neurologist and the neurosurgeon are highlighted.
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