title: Transcranial Doppler ultrasonography in sickle cell disease: a study in Omani patients.
abstract: Changes on Transcranial Doppler (TCD) ultrasonography have been proposed as significant predictors of cerebrovascular complications in sickle cell disease (SCD). However, consensus with regards to the TCD criteria to recognize abnormalities in cerebral vasculature is lacking. We studied the TCD characteristics of cerebral arteries among Omani patients with SCD and correlated them with cerebrovascular events. TCD was performed through the temporal and suboccipital windows using a 2 MHz probe (DWL). Thirty-three of 59 patients (56%) with SCD had neurological symptoms including stroke--12 (20%) and epilepsy--7. Fifteen patients (25%) had significant TCD abnormalities including: markedly increased velocities--11 (3 with stroke); turbulent flow--2; and reversal of flow--2. No patient had a time averaged maximum mean velocity of >200 cm/s in anterior circulation. On applying a modified definition of "abnormal TCD" to anterior and posterior circulation studies, increased TCD velocities in posterior circulation correlated with history of stroke (P < 0.05). TCD velocities in the 18 adult patients ( older than 15 y) were significantly lower than in children. Logistic regression analysis revealed abnormal TCD in the left posterior cerebral artery to be an independent predictor of stroke in this cohort (P = 0.035).
authors.affiliation: Department of Medicine (Neurology), College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman.
authors.forename: Arunodaya R
authors.initials: AR
authors.lastname: Gujjar
authors.forename: Mathew
authors.initials: M
authors.lastname: Zacharia
authors.forename: Salam
authors.initials: S
authors.lastname: Al-Kindi
authors.forename: Ranjan
authors.initials: R
authors.lastname: William
authors.forename: Zakiya
authors.initials: Z
authors.lastname: Al Lamki
authors.forename: Yasser
authors.initials: Y
authors.lastname: Wali
authors.forename: Wafa
authors.initials: W
authors.lastname: Bashir
authors.forename: Rajeev
authors.initials: R
authors.lastname: Jain
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Asmi
authors.forename: Anil
authors.initials: A
authors.lastname: Pathare
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000000981:diagnostic imaging; D002536:Cerebral Arteries / Q000000981:diagnostic imaging* / Q000473:pathology; D002560:Cerebrovascular Circulation; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009850:Oman; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology; D017585:Ultrasonography, Doppler, Transcranial