Silent stroke in a case of beta-thalassemia major associated with chronic renal failure and diabetes mellitus.
Severe anemia, growth retardation, diabetes mellitus, cardiac disorders, and, infrequently, stroke are well-known complications of thalassemia major. We report a girl, age 7 years, 2 months, with beta-thalassemia major associated with chronic renal failure, diabetes mellitus, and cardiomyopathy in whom a silent stroke was noted during follow-up. She was diagnosed with thalassemia major at age 6 months, chronic renal failure at age 3 years, 3 months, and diabetes mellitus and cardiomyopathy at age 7 years. Although cranial computed tomography was found to be normal at the age of 3 years, 3 months, magnetic resonance imaging showed cerebral infarct in the right frontal region at 7 years, 2 months. A thrombophilic panel revealed increased factor VIII and decreased protein C concentrations. She died from disseminated intravascular coagulation at age 7 years, 9 months. We did not record any clinical findings of stroke during her follow-up. We think that diabetes mellitus, dilated cardiomyopathy, and increased factor VIII and decreased protein C concentrations led to the occurrence of cerebral infarct. In conclusion, we emphasize that children with thalassemia major should be monitored closely for stroke. We also suggest that stroke can show a silent progression in severely affected children, as in our case.
Caksen
Hüseyin
H
Department of Pediatrics, Yüzüncü Yýl University Faculty of Medicine, Van, Turkey. huseyincaksen@hotmail.com
Odabaş
Dursun
D
Akbayram
Sinan
S
Faik Oner
Ahmet
A
Arslan
Sükrü
S
Cesur
Yaşar
Y
Uner
Abdurrahman
A
D002648:Child; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D020521:Stroke / Q000209:etiology*; D017086:beta-Thalassemia / Q000150:complications*