title: Central nervous system events in children with sickle cell disease presenting acutely with headache.
abstract: OBJECTIVE
  To determine the frequency of acute care visits and risk factors for central nervous system (CNS) events in children with homozygous sickle cell disease (SCD-SS) with an acute headache.
  
  
  METHODS
  This is a retrospective cohort study of acute care visits for headache in children with SCD-SS. The prevalence of headache visits, neuroimaging evaluation, and acute CNS events were calculated and clinical and laboratory variables assessed.
  
  
  RESULTS
  Headache was the chief complaint in 102 of 2685 acute care visits (3.8%) by children with SCD-SS. Acute CNS events were detected in 6.9% of these visits. Neuroimaging was performed in 42.2% of visits, and acute CNS events were identified in 16.3% of studies. Factors associated with acute CNS events included older age, history of stroke, transient ischemic attack, or seizure, neurologic symptoms, focal neurologic exam findings, and elevated platelets.
  
  
  CONCLUSIONS
  Acute headache is common in pediatric SCD-SS and more frequently associated with acute CNS events than in the general pediatric population. A history of stroke, transient ischemic attack, seizures, neurologic symptoms, focal neurologic exam, or elevated platelet counts at presentation warrant confirmatory imaging studies. Whether a more limited workup is adequate for other children should be confirmed in a larger, prospective study.
authors: Division of Hematology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
authors: Patrick C
authors: PC
authors: Hines
authors: Therese P
authors: TP
authors: McKnight
authors: Wendy
authors: W
authors: Seto
authors: Janet L
authors: JL
authors: Kwiatkowski
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000755:Anemia, Sickle Cell / Q000453:epidemiology*; D001921:Brain / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006261:Headache / Q000453:epidemiology*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D007958:Leukocyte Count; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D010976:Platelet Count; D012189:Retrospective Studies; D012640:Seizures / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D055815:Young Adult