Sickle-cell disease stroke throughout life: a retrospective study in an adult referral center.
Strokes are one of the most severe complications of sickle-cell disease. Most studies have been restricted to children with sickle-cell disease. To better understand the characteristics and follow-up of strokes occurring from childhood to adulthood, we undertook a retrospective cohort study of 69 stroke patients among the 2,875 patients consulting at the French Adult Sickle-Cell Disease Referral Center. Between 1970 and 2008, they had experienced 104 strokes: 80 ischemic, 22 hemorrhagic, and 2 intracranial sinus thromboses. Coma and/or fatal outcomes underscored the severity of strokes in sickle-cell disease patients.Hemorrhagic strokes occurred mostly in adults and carried a higher risk of death than ischemic stroke. The mechanisms underlying sickle-cell disease associated strokes were reevaluated and etiologies were determined for first stroke and recurrences, in childhood and adulthood. Sickle-cell disease vasculopathy concerned only SS patients and remains their most frequent stroke etiology. Cardioembolism, vaso-occlusive crisis and triggering factors were other etiologies identified in adults. Recurrences occurred in 19 SS patients only after a first ischemic stroke. SC patients' strokes occurred in adulthood and were associated with cardiovascular risk factors. Our findings provide novel information about cerebrovascular pathologies throughout the lives of sickle-cell disease patients and suggest the need for different diagnostic and therapeutic management approaches in those different settings.
Antoine
A
Gueguen
Matthieu
M
Mahevas
Ruben
R
Nzouakou
Hassan
H
Hosseini
Anoosha
A
Habibi
Dora
D
Bachir
Pierre
P
Brugière
François
F
Lionnet
Jean-Antoine
JA
Ribei
Bertrand
B
Godeau
Robert
R
Girot
Vahid
V
Ibrahima
David
D
Calvet
Frédéric
F
Galactéros
Pablo
P
Bartolucci
D000328:Adult; D017668:Age of Onset; D000368:Aged; D000755:Anemia, Sickle Cell / Q000150:complications*; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000145:classification / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult