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Published on: June 3, 2021
Transcranial Doppler ultrasonography in sickle cell disease: a study in Omani patients
Arunodaya R Gujjar1, Mathew Zacharia, Salam Al-Kindi
1Department of Medicine (Neurology), College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman.
Insights
Transcranial Doppler (TCD) can predict stroke in sickle cell disease (SCD). Abnormal TCD findings in the left posterior cerebral artery independently predicted stroke in Omani patients with SCD.
Area of Science:
- Neurology
- Vascular Medicine
- Medical Imaging
Background:
- Cerebrovascular complications are a major concern in sickle cell disease (SCD).
- Transcranial Doppler (TCD) ultrasonography shows promise in predicting these complications.
- Standardized criteria for abnormal TCD findings in SCD are currently lacking.
Purpose of the Study:
- To investigate TCD characteristics of cerebral arteries in Omani patients with SCD.
- To correlate TCD findings with cerebrovascular events, particularly stroke.
- To identify specific TCD criteria predictive of stroke in this population.
Main Methods:
- TCD ultrasonography was performed on 59 Omani patients with SCD using a 2 MHz probe.
- Neurological symptoms, including stroke and epilepsy, were recorded.
- TCD data were analyzed for velocities, flow patterns, and compared with clinical outcomes.
Main Results:
- 56% of patients had neurological symptoms; 20% had experienced stroke.
- 25% of patients exhibited significant TCD abnormalities (increased velocities, turbulent flow, reversed flow).
- Abnormal TCD velocities in the posterior circulation correlated with stroke history (P < 0.05).
- Abnormal TCD in the left posterior cerebral artery was an independent predictor of stroke (P = 0.035).
Conclusions:
- Modified TCD criteria can identify cerebrovascular abnormalities in SCD patients.
- Increased TCD velocities in the posterior circulation are associated with stroke risk.
- Left posterior cerebral artery abnormalities on TCD are a significant independent predictor of stroke in SCD.
Abstract:
Changes on Transcranial Doppler (TCD) ultrasonography have been proposed as significant predictors of cerebrovascular complications in sickle cell disease (SCD). However, consensus with regards to the TCD criteria to recognize abnormalities in cerebral vasculature is lacking. We studied the TCD characteristics of cerebral arteries among Omani patients with SCD and correlated them with cerebrovascular events. TCD was performed through the temporal and suboccipital windows using a 2 MHz probe (DWL). Thirty-three of 59 patients (56%) with SCD had neurological symptoms including stroke--12 (20%) and epilepsy--7. Fifteen patients (25%) had significant TCD abnormalities including: markedly increased velocities--11 (3 with stroke); turbulent flow--2; and reversal of flow--2. No patient had a time averaged maximum mean velocity of >200 cm/s in anterior circulation. On applying a modified definition of "abnormal TCD" to anterior and posterior circulation studies, increased TCD velocities in posterior circulation correlated with history of stroke (P < 0.05). TCD velocities in the 18 adult patients ( older than 15 y) were significantly lower than in children. Logistic regression analysis revealed abnormal TCD in the left posterior cerebral artery to be an independent predictor of stroke in this cohort (P = 0.035).
