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Long-term stroke risk in children with sickle cell disease screened with transcranial Doppler
R J Adams1, V C McKie, E M Carl
1Department of Neurology, Medical College of Georgia, Augusta 30912, USA.
Insights
Transcranial Doppler (TCD) effectively identifies stroke risk in children with sickle cell disease. Elevated blood flow velocities, particularly 200 cm/sec or higher, strongly predict stroke, guiding primary prevention strategies.
Area of Science:
- Neurology
- Hematology
- Pediatrics
Background:
- Stroke is a significant complication in sickle cell disease (SCD).
- Early stroke prediction is crucial for implementing primary prevention measures.
- Previous research identified elevated velocities in intracranial arteries via transcranial Doppler (TCD) as a stroke risk indicator.
Purpose of the Study:
- To extend previous findings on TCD and stroke risk in SCD.
- To incorporate intracranial hemorrhage into the stroke-risk model.
- To analyze stroke risk with a larger cohort and longer follow-up.
Main Methods:
- Utilized transcranial Doppler (TCD) to measure blood flow velocities in intracranial arteries.
- Included 125 additional children in the study cohort.
- Extended the follow-up duration for participants.
- Integrated intracranial hemorrhage data into the stroke-risk assessment.
Main Results:
- Elevated time-averaged mean maximum blood flow velocity, especially ≥200 cm/sec by TCD, showed a strong association with increased stroke risk.
- The study confirmed the predictive value of TCD for ischemic stroke in children with SCD.
- Identified cases where TCD did not predict stroke, highlighting limitations.
Conclusions:
- TCD is a valuable tool for identifying children with sickle cell disease at high risk for stroke.
- The findings emphasize the importance of monitoring blood flow velocities to guide preventative interventions.
- Further research is needed to optimize TCD surveillance timing and address unpredicted stroke cases.
Abstract:
Stroke is an important complication of sickle cell disease. Stroke prediction is clinically important because it offers the possibility of primary prevention. In 1992, transcranial Doppler (TCD) evidence of elevated intracranial internal carotid or middle cerebral artery velocity was demonstrated to be associated strongly with an increased risk of ischemic stroke. This study extends the original study and includes 125 more children, longer follow-up, and intracranial hemorrhage in the stroke-risk model. Elevated time averaged mean maximum blood flow velocity, especially when velocity is 200 cm/sec or greater by TCD, was associated strongly with stroke risk. The cases not predicted by TCD point to the need for more information on the optimal timing of TCD surveillance for stroke risk.