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Cerebral haemorrhagic risk in children with sickle-cell disease

Manoelle Kossorotoff1, Valentine Brousse, David Grevent

  • 1Paediatric Neurology, French Centre for Paediatric Stroke, Necker-Enfants Malades University Hospital, APHP and Inserm UMR-S1140, Paris, France.

Developmental Medicine and Child Neurology
|September 2, 2014
PubMed

Insights

Modern stroke prevention strategies did not alter the risk ratio of hemorrhagic to ischemic events in children with sickle cell disease (SCD). Intracranial aneurysms in pediatric SCD share traits with adult SCD, suggesting a common pathophysiology.

Area of Science:

  • Pediatric Neurology
  • Hematology
  • Vascular Medicine

Background:

  • Sickle cell disease (SCD) poses a significant risk for cerebrovascular events in children.
  • Modern stroke prevention strategies aim to mitigate these risks, but their impact on hemorrhagic complications requires further investigation.

Purpose of the Study:

  • To evaluate the risk of cerebral hemorrhage in children with SCD managed with contemporary stroke prevention methods.
  • To characterize intracranial aneurysms in pediatric SCD and compare them to adult SCD findings.

Main Methods:

  • A retrospective analysis of a pediatric SCD cohort over a 9-year period.
  • Defining hemorrhagic risk by intracranial hemorrhage or aneurysm diagnosis.
  • Defining ischemic risk by ischemic events or neuroimaging findings.

Main Results:

  • Among 251 patients, 36 had ischemic risk and 7 had hemorrhagic risk; 5 patients had both.
  • The average age at first hemorrhagic symptom was older (10.4 years) compared to ischemic risk (6.2 years).
  • Nine intracranial saccular aneurysms were identified, predominantly in the posterior circulation.

Conclusions:

  • The ratio of ischemic to hemorrhagic risk in pediatric SCD remains unchanged despite modern management.
  • Pediatric SCD-associated intracranial aneurysms exhibit characteristics similar to those in adults with SCD.
  • Findings suggest a shared pathophysiology between anterior stenosis and posterior dilation in SCD, potentially guiding unified management strategies.
Abstract

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