title: Cervical carotid artery disease in sickle cell anemia: clinical and radiological features.
abstract: Cervical internal carotid artery (cICA) occlusion is a recognized cause of acute ischemic stroke (AIS) in sickle cell disease (SCD), but the associated clinical and radiologic features are not well described. We reviewed data on cervical magnetic resonance angiography (cMRA) performed prospectively in 67 patients (55 children) for indications including transcranial Doppler (TCD) abnormalities, AIS, or previous AIS. cICA lesions were seen in 10 (15%) patients, including 4 of 7 patients presenting with AIS, and appear to have been missed on first presentation in 4 of 10 patients with previous AIS. Radiologic features in 7 patients were consistent with dissection. In 2 patients, there was strong clinical and radiologic evidence for thromboembolic AIS, and this was also considered possible in 4 other patients. Three of the 4 AIS patients were anticoagulated acutely, and the nontreated patient had recurrent, probably thromboembolic, AIS. TCD findings were variable, but in 4 patients there were high velocities in the cerebral vessels contralateral to the cICA stenosis. We suggest that all patients with AIS should have cMRA during acute evaluation to identify cICA occlusions that may require anticoagulation. Routine screening of children with SCD should also include evaluation of neck vessels by carotid Doppler followed by cMRA if a cervical vascular lesion is suspected.
authors: Department of Pediatric Hematology, Barts and The London Hospital National Health Service Trust (NHST), London, United Kingdom. paul.telfer@bartsandthelondon.nhs.uk
authors: Paul T
authors: PT
authors: Telfer
authors: Jane
authors: J
authors: Evanson
authors: Paul
authors: P
authors: Butler
authors: Claire
authors: C
authors: Hemmaway
authors: Chenya
authors: C
authors: Abdulla
authors: Nimze
authors: N
authors: Gadong
authors: Simon
authors: S
authors: Whitmarsh
authors: Banu
authors: B
authors: Kaya
authors: Fenella J
authors: FJ
authors: Kirkham
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000188:drug therapy; D000925:Anticoagulants / Q000627:therapeutic use; D002341:Carotid Artery Thrombosis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D002574:Cervical Vertebrae; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D009333:Neck; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000925:Anticoagulants