Stroke in sickle cell anemia: alternative etiologies.
Stroke is common in children with sickle cell anemia, but is rarely attributed to the traditional causes of stroke identified in other children. An 11-year-old girl with sickle cell anemia presented with severe headache and was found to have recurrent bilateral multifocal strokes in a cardioembolic pattern. Evaluation revealed the presence of a patent foramen ovale, antiphospholipid antibodies, and elevations in factor VIII and lipoprotein(a). Sickle cell anemia is itself a hypercoagulable state with potential for increased right heart pressures, both of which predispose to paradoxical embolization via right-to-left intracardiac shunting of emboli, thus causing stroke. The present case suggests that the more traditional etiologies for pediatric stroke may also cause stroke in children with sickle cell anemia.
Dowling
Michael M
MM
Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9063, USA. Michael.dowling@utsouthwestern.edu
Quinn
Charles T
CT
Rogers
Zora R
ZR
Journeycake
Janna M
JM
D000755:Anemia, Sickle Cell / Q000150:complications*; D017152:Antibodies, Antiphospholipid / Q000378:metabolism; D001921:Brain / Q000098:blood supply / Q000473:pathology; D002648:Child; D005169:Factor VIII / Q000378:metabolism; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications; D006801:Humans; D017270:Lipoprotein(a) / Q000378:metabolism; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D020521:Stroke / Q000209:etiology* / Q000628:therapy
D017152:Antibodies, Antiphospholipid; D017270:Lipoprotein(a); D005169:Factor VIII