title: First Ischemic Stroke in Sickle-Cell Disease: Are There Any Adult Specificities?
abstract: OBJECTIVE
  There is little evidence about characteristics of ischemic stroke (IS) occurring in adults with sickle-cell disease (SCD). The objective of this study was to assess characteristics of first-ever IS in adults with SCD and to assess whether they differ from those occurring in child patients with SCD.
  
  
  METHODS
  Adult and child individuals with SCD who had a first-ever IS were identified from cohorts of patients followed up in an adult and a child sickle cell referral center. Mechanisms of IS were determined by consensus meeting from all available explorations using the following predefined classification: Vasculopathy, cardioembolism, other defined cause, and undetermined. Treatment and stroke recurrences were recorded from prospective follow-up performed in the referral centers.
  
  
  RESULTS
  Twenty-nine adults and 26 children had a first-ever IS; mean age (SD) was 7.1 (4.3) and 32.3 (11.6), respectively. With regard to IS mechanism, vasculopathy was less often the cause of IS in adults (12/29, 41%) than in children (24/26, 92%; P<0.001). Other causes of IS in adults were cardioembolism in 7, antiphospholipid syndrome in 1, toxic (cocaine) in 1, and undetermined in 8. Adults with SCD had a higher risk of recurrent stroke (23.1% [7.0-39.2] at 5 years) compared with children (1 recurrence only; P log rank=0.046) despite exchange-blood transfusion in patients with vasculopathy.
  
  
  CONCLUSIONS
  First-ever IS occurring in adults with SCD has specificities that justify further studies conducted in adults with SCD to improve understanding and management.
authors.affiliation: From the Department of Neurology Hôpital Sainte-Anne, Université Paris-Descartes, INSERM 894, DHU Neurovasc-Paris Sorbonne, Paris, France (D.C.); Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Créteil, France (F.B.); Fondation Ophtalmologique A. de Rothschild, Paris, France (A.G.); Service de Neurologie, Hôpital Henri-Mondor, UPEC, Créteil, France (H.H.); Department of Neurology Sickle cell referral center, médecine interne, Hôpital Henri-Mondor, UPEC, Créteil, France (A.H, F.G., P.B.); and INSERM U955, team 2, Laboratoire d'Excellence Grex, Créteil, France (A.H, F.G., P.B.).
authors.forename: David
authors.initials: D
authors.lastname: Calvet
authors.affiliation: From the Department of Neurology Hôpital Sainte-Anne, Université Paris-Descartes, INSERM 894, DHU Neurovasc-Paris Sorbonne, Paris, France (D.C.); Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Créteil, France (F.B.); Fondation Ophtalmologique A. de Rothschild, Paris, France (A.G.); Service de Neurologie, Hôpital Henri-Mondor, UPEC, Créteil, France (H.H.); Department of Neurology Sickle cell referral center, médecine interne, Hôpital Henri-Mondor, UPEC, Créteil, France (A.H, F.G., P.B.); and INSERM U955, team 2, Laboratoire d'Excellence Grex, Créteil, France (A.H, F.G., P.B.).
authors.forename: Françoise
authors.initials: F
authors.lastname: Bernaudin
authors.affiliation: From the Department of Neurology Hôpital Sainte-Anne, Université Paris-Descartes, INSERM 894, DHU Neurovasc-Paris Sorbonne, Paris, France (D.C.); Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Créteil, France (F.B.); Fondation Ophtalmologique A. de Rothschild, Paris, France (A.G.); Service de Neurologie, Hôpital Henri-Mondor, UPEC, Créteil, France (H.H.); Department of Neurology Sickle cell referral center, médecine interne, Hôpital Henri-Mondor, UPEC, Créteil, France (A.H, F.G., P.B.); and INSERM U955, team 2, Laboratoire d'Excellence Grex, Créteil, France (A.H, F.G., P.B.).
authors.forename: Antoine
authors.initials: A
authors.lastname: Gueguen
authors.affiliation: From the Department of Neurology Hôpital Sainte-Anne, Université Paris-Descartes, INSERM 894, DHU Neurovasc-Paris Sorbonne, Paris, France (D.C.); Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Créteil, France (F.B.); Fondation Ophtalmologique A. de Rothschild, Paris, France (A.G.); Service de Neurologie, Hôpital Henri-Mondor, UPEC, Créteil, France (H.H.); Department of Neurology Sickle cell referral center, médecine interne, Hôpital Henri-Mondor, UPEC, Créteil, France (A.H, F.G., P.B.); and INSERM U955, team 2, Laboratoire d'Excellence Grex, Créteil, France (A.H, F.G., P.B.).
authors.forename: Hassan
authors.initials: H
authors.lastname: Hosseini
authors.affiliation: From the Department of Neurology Hôpital Sainte-Anne, Université Paris-Descartes, INSERM 894, DHU Neurovasc-Paris Sorbonne, Paris, France (D.C.); Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Créteil, France (F.B.); Fondation Ophtalmologique A. de Rothschild, Paris, France (A.G.); Service de Neurologie, Hôpital Henri-Mondor, UPEC, Créteil, France (H.H.); Department of Neurology Sickle cell referral center, médecine interne, Hôpital Henri-Mondor, UPEC, Créteil, France (A.H, F.G., P.B.); and INSERM U955, team 2, Laboratoire d'Excellence Grex, Créteil, France (A.H, F.G., P.B.).
authors.forename: Anoosha
authors.initials: A
authors.lastname: Habibi
authors.affiliation: From the Department of Neurology Hôpital Sainte-Anne, Université Paris-Descartes, INSERM 894, DHU Neurovasc-Paris Sorbonne, Paris, France (D.C.); Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Créteil, France (F.B.); Fondation Ophtalmologique A. de Rothschild, Paris, France (A.G.); Service de Neurologie, Hôpital Henri-Mondor, UPEC, Créteil, France (H.H.); Department of Neurology Sickle cell referral center, médecine interne, Hôpital Henri-Mondor, UPEC, Créteil, France (A.H, F.G., P.B.); and INSERM U955, team 2, Laboratoire d'Excellence Grex, Créteil, France (A.H, F.G., P.B.).
authors.forename: Frédéric
authors.initials: F
authors.lastname: Galactéros
authors.affiliation: From the Department of Neurology Hôpital Sainte-Anne, Université Paris-Descartes, INSERM 894, DHU Neurovasc-Paris Sorbonne, Paris, France (D.C.); Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Créteil, France (F.B.); Fondation Ophtalmologique A. de Rothschild, Paris, France (A.G.); Service de Neurologie, Hôpital Henri-Mondor, UPEC, Créteil, France (H.H.); Department of Neurology Sickle cell referral center, médecine interne, Hôpital Henri-Mondor, UPEC, Créteil, France (A.H, F.G., P.B.); and INSERM U955, team 2, Laboratoire d'Excellence Grex, Créteil, France (A.H, F.G., P.B.). pablo.bartolucci@hmn.aphp.fr.
authors.forename: Pablo
authors.initials: P
authors.lastname: Bartolucci
mesh_terms: D000328:Adult; D000367:Age Factors; D000755:Anemia, Sickle Cell / Q000175:diagnosis / Q000453:epidemiology*; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult
keywords: adult; anemia, sickle cell; child; follow-up studies; stroke