title: Cerebral haemorrhagic risk in children with sickle-cell disease.
abstract: OBJECTIVE
  To address risk of first or recurrent cerebral haemorrhage in children with sickle-cell disease (SCD) who are being managed with modern stroke prevention strategies.
  
  
  METHODS
  A systematically followed SCD paediatric cohort was retrospectively studied over a 9-year period. Haemorrhagic risk was defined as intracranial haemorrhage occurrence or intracranial aneurysm diagnosis during the study period. Ischaemic risk was defined as cerebrovascular ischaemic event occurrence or transcranial Doppler/magnetic resonance imaging hallmarks of ischaemic risk finding during the study period.
  
  
  RESULTS
  Among the 251 patients in the cohort, 36 patients were included in the ischaemic group. Seven patients were included in the haemorrhagic group, of which five also met the criteria for the ischaemic group. Age at first haemorrhagic symptom/hallmark of risk was older (10.4 vs 6.2 years old, p=0.036). Nine intracranial saccular aneurysms were found, mostly on the posterior circulation. Two patients had endovascular embolization.
  
  
  CONCLUSIONS
  The ratio of ischaemic to haemorrhagic risk was not modified with modern management compared with historical series. Intracranial aneurysm in children with SCD had specific characteristics, close to intracranial aneurysms described in adults with SCD. Data favoured concurrent development of intracranial SCD-associated anterior stenosis and posterior dilation, suggesting common pathophysiology and management strategies.
authors.affiliation: Paediatric Neurology, French Centre for Paediatric Stroke, Necker-Enfants Malades University Hospital, APHP and Inserm UMR-S1140, Paris, France.
authors.forename: Manoelle
authors.initials: M
authors.lastname: Kossorotoff
authors.forename: Valentine
authors.initials: V
authors.lastname: Brousse
authors.forename: David
authors.initials: D
authors.lastname: Grevent
authors.forename: Olivier
authors.initials: O
authors.lastname: Naggara
authors.forename: Francis
authors.initials: F
authors.lastname: Brunelle
authors.forename: Thomas
authors.initials: T
authors.lastname: Blauwblomme
authors.forename: Pascale
authors.initials: P
authors.lastname: Gaussem
authors.forename: Isabelle
authors.initials: I
authors.lastname: Desguerre
authors.forename: Mariane
authors.initials: M
authors.lastname: De Montalembert
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000453:epidemiology* / Q000473:pathology; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control / Q000628:therapy; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control / Q000628:therapy; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D017585:Ultrasonography, Doppler, Transcranial