title: Acute silent cerebral ischemia and infarction during acute anemia in children with and without sickle cell disease.
abstract: We hypothesized that the silent cerebral infarcts (SCI), which affect up to 40% of children with sickle cell disease (SCD), could occur in the setting of acute anemic events. In a prospective observational study of children with and without SCD hospitalized for an illness associated with acute anemia, we identified acute silent cerebral ischemic events (ASCIE) in 4 (18.2%) of 22 with SCD and in 2 (6.7%) of 30 without SCD, using diffusion-weighted magnetic resonance imaging. Children with ASCIE had lower hemoglobin concentration than those without (median 3.1 vs 4.4 g/dL, P = .003). The unique temporal features of stroke on diffusion-weighted magnetic resonance imaging permit estimation of incidence rates for ASCIE of 421 (95% confidence interval, 155-920) per 100 patient-years during acute anemic events for all patients. For children with SCD, the estimated incidence was 663 (95% confidence interval, 182-1707) which is much higher than previously reported. Acute anemic events are common in children with SCD and prevalence could partially account for the high SCI. Some ASCIE (1 of 4 in our study) may be reversible. Alterations in management may be warranted for children with severe anemia to identify unrecognized ischemic brain injury that may have permanent neurocognitive sequelae.
authors.affiliation: Departments of Pediatrics, University of Texas Southwestern Medical Center and Children’s Medical Center, Dallas, TX 75390-9063, USA. michael.dowling@utsouthwestern.edu
authors.forename: Michael M
authors.initials: MM
authors.lastname: Dowling
authors.forename: Charles T
authors.initials: CT
authors.lastname: Quinn
authors.forename: Patricia
authors.initials: P
authors.lastname: Plumb
authors.forename: Zora R
authors.initials: ZR
authors.lastname: Rogers
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Rollins
authors.forename: Korgun
authors.initials: K
authors.lastname: Koral
authors.forename: George R
authors.initials: GR
authors.lastname: Buchanan
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000150:complications* / Q000209:etiology; D000755:Anemia, Sickle Cell / Q000150:complications; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology