[Cerebral infarct and hemorrhage in patients with sickle cell disease]

Two sickle cell patients with cerebral accidents, infarct and bleeding, are presented. Up to 15% of all sickle cell patients suffer cerebral events, 75% of which are infarcts, 25% intracranial hemorrhages. Infarcts occur predominantly in children with a clustering around age 7, while bleeding predominates in adult life. Cerebral events are due to intimal changes, proliferation and finally occlusion of both small and large cerebral arteries. Infarcts present with hemiparesis, aphasia, loss of vision and seizures whereas intracranial bleedings are associated with severe headache and/or loss of consciousness and coma. When cerebral infarct is suspected, magnetic resonance imaging is the diagnostic method of choice. Intracranial bleeding is best diagnosed by computed tomography or angiography. Partial exchange transfusion is indicated in both events to be followed by a chronic transfusion program of as yet undetermined length. Routine magnetic resonance angiogram and/or transcranial doppler sonography in young asymptomatic sickle cell patients may make it possible in the future to detect patients at risk and institute treatment prior to a cerebral accident.