PEDIATRICS Vol. 103 No. 3 March 1999, pp. 640-645
Silent Cerebral Infarcts in Sickle Cell Anemia: A Risk Factor Analysis
Received Apr 6, 1998; accepted Aug 21, 1998.
,
,,,
From the * Department of Pediatrics, Duke Children's Hospital,
Duke University Medical Center, Durham, North Carolina; New England
Research Institutes, Inc, Watertown, Massachusetts; § St Jude's
Children's Research Hospital, Department of Hematology/Oncology,
Memphis, Tennessee; Department of Neuroradiology, Children's
Hospital of Philadelphia, Philadelphia, Pennsylvania; ¶ Division of
Pediatric Hematology, University of Miami, Miami, Florida; # Department
of Hematology, Children's Hospital of Philadelphia, Philadelphia,
Pennsylvania; ** Comprehensive Sickle Cell Center, St Luke's/Roosevelt
Hospital, New York, New York; Division of Neuroradiology,
Montefiore Medical Center, Bronx, New York; §§ Department of
Hematology/Oncology, Children's Hospital Medical Center of Northern
California, Oakland, California; || Department of
Imaging, Cedars-Sinai Medical Center, Los Angeles, California;
¶¶ Department of Pediatric Hematology/Oncology, St Louis Children's
Hospital, Missouri; ## Department of Laboratory Medicine, Boston
Children's Hospital, Boston, Massachusetts; and *** Pediatric Sickle
Cell Program, SUNY Health Science Center at Brooklyn, New York.
Background. Silent infarcts have been reported in 17% of young patients with sickle cell disease and are associated with impaired performance on standardized psychometric tests. Risk factors for the development of these lesions have not been identified.
Methods. Investigators in the Cooperative Study of Sickle Cell Disease performed a brain magnetic resonance imaging scan on sickle cell anemia patients age 5.9 years and older who had been followed according to the protocols of the Cooperative Study since birth. Individuals with a known history of cerebrovascular accident were excluded from this analysis. Patients with and without silent infarctions were compared with regard to clinical and laboratory parameters.
Results. The study sample included 42 patients (18.3%)
with silent infarcts. Patients who had silent infarcts were
significantly more likely to have a clinical history of seizure and a
lower painful event rate. Lower hemoglobin level, increased
leukocyte count, elevated pocked red blood cell count, and SEN
S globin gene haplotype were associated also with the
presence of silent infarcts. There was no relationship between silent
infarcts and platelet count, fetal hemoglobin level, reticulocyte
percentage, serum aspartate aminotransferase level, total bilirubin
concentration, blood pressure, growth parameters, or presence of
-thalassemia. A multivariate model for silent infarction identified
the following as risk factors: low pain event rate, history of seizure,
leukocyte count 
11.8 × 109/L, and the SEN
S globin gene haplotype.
Conclusions. Patients with risk factors for silent infarcts should be evaluated for cerebrovascular disease. If evidence of infarction is found, consideration must be given to therapeutic intervention. At present, the appropriate treatment has not been determined. Key words: sickle cell disease, cerebral infarction.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  G. S. Silva, P. Vicari, M. S. Figueiredo, H. Carrete Junior, M. H. Idagawa, and A. R. Massaro Brain Magnetic Resonance Imaging Abnormalities in Adult Patients With Sickle Cell Disease: Correlation With Transcranial Doppler Findings Stroke, July 1, 2009; 40(7): 2408 - 2412. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Zennadi, A. Chien, K. Xu, M. Batchvarova, and M. J. Telen Sickle red cells induce adhesion of lymphocytes and monocytes to endothelium Blood, October 15, 2008; 112(8): 3474 - 3483. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. D. Nandedkar, T. R. Feroah, W. Hutchins, D. Weihrauch, K. S. Konduri, J. Wang, R. C. Strunk, M. R. DeBaun, C. A. Hillery, and K. A. Pritchard Histopathology of experimentally induced asthma in a murine model of sickle cell disease Blood, September 15, 2008; 112(6): 2529 - 2538. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Chang Milbauer, P. Wei, J. Enenstein, A. Jiang, C. A. Hillery, J. P. Scott, S. C. Nelson, V. Bodempudi, J. N. Topper, R.-B. Yang, et al. Genetic endothelial systems biology of sickle stroke risk Blood, April 1, 2008; 111(7): 3872 - 3879. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. S. Platt Prevention and Management of Stroke in Sickle Cell Anemia Hematology, January 1, 2006; 2006(1): 54 - 57. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. C. Mahaney, C. Brugnara, L. R. Lease, and O. S. Platt Genetic influences on peripheral blood cell counts: a study in baboons Blood, August 15, 2005; 106(4): 1210 - 1214. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. S. Coller Leukocytosis and Ischemic Vascular Disease Morbidity and Mortality: Is It Time to Intervene? Arterioscler. Thromb. Vasc. Biol., April 1, 2005; 25(4): 658 - 670. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Monagle, A. Chan, P. Massicotte, E. Chalmers, and A. D. Michelson Antithrombotic Therapy in Children*: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 645S - 687S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Jison, P. J. Munson, J. J. Barb, A. F. Suffredini, S. Talwar, C. Logun, N. Raghavachari, J. H. Beigel, J. H. Shelhamer, R. L. Danner, et al. Blood mononuclear cell gene expression profiles characterize the oxidant, hemolytic, and inflammatory stress of sickle cell disease Blood, July 1, 2004; 104(1): 270 - 280. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Hoppe, W. Klitz, S. Cheng, R. Apple, L. Steiner, L. Robles, T. Girard, E. Vichinsky, and L. Styles Gene interactions and stroke risk in children with sickle cell anemia Blood, March 15, 2004; 103(6): 2391 - 2396. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Henry, M. C. Driscoll, M. Miller, T. Chang, and C. P. Minniti Pseudotumor Cerebri in Children With Sickle Cell Disease: A Case Series Pediatrics, March 1, 2004; 113(3): e265 - 269. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. R. Buchanan, M. R. DeBaun, C. T. Quinn, and M. H. Steinberg Sickle Cell Disease Hematology, January 1, 2004; 2004(1): 35 - 47. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. T. Miller, S. P. Rao, J. H. Boyd, and M. R. DeBaun Acute chest syndrome, transfusion, and neurologic events in children with sickle cell disease Blood, August 15, 2003; 102(4): 1556 - 1557. [Full Text] [PDF]
|
|
|
|
|
|
N. Perelman, S. K. Selvaraj, S. Batra, L. R. Luck, A. Erdreich-Epstein, T. D. Coates, V. K. Kalra, and P. Malik Placenta growth factor activates monocytes and correlates with sickle cell disease severity Blood, August 15, 2003; 102(4): 1506 - 1514. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Hoppe, W. Klitz, J. Noble, L. Vigil, E. Vichinsky, and L. Styles Distinct HLA associations by stroke subtype in children with sickle cell anemia Blood, April 1, 2003; 101(7): 2865 - 2869. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G. T. VI, D. C. Tang, S. A. Savage, S. F. Leitman, S. I. Heller, G. R. Serjeant, G. P. Rodgers, and S. J. Chanock Variants in the VCAM1 gene and risk for symptomatic stroke in sickle cell disease Blood, December 15, 2002; 100(13): 4303 - 4309. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. S. Kean, M. M. Durham, A. B. Adams, L. L. Hsu, J. R. Perry, D. Dillehay, T. C. Pearson, E. K. Waller, C. P. Larsen, and D. R. Archer A cure for murine sickle cell disease through stable mixed chimerism and tolerance induction after nonmyeloablative conditioning and major histocompatibility complex-mismatched bone marrow transplantation Blood, March 1, 2002; 99(5): 1840 - 1849. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. C. Walters, A. W. Nienhuis, and E. Vichinsky Novel Therapeutic Approaches in Sickle Cell Disease Hematology, January 1, 2002; 2002(1): 10 - 34. [Abstract] [Full Text]
|
|
|
|
|
|
A. Eldor and E. A. Rachmilewitz The hypercoagulable state in thalassemia Blood, January 1, 2002; 99(1): 36 - 43. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. H. Pegelow, W. Wang, S. Granger, L. L. Hsu, E. Vichinsky, F. G. Moser, J. Bello, R. A. Zimmerman, R. J. Adams, D. Brambilla, et al. Silent Infarcts in Children With Sickle Cell Anemia and Abnormal Cerebral Artery Velocity Arch Neurol, December 1, 2001; 58(12): 2017 - 2021. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Adams, K. Ohene-Frempong, and W. Wang Sickle Cell and the Brain Hematology, January 1, 2001; 2001(1): 31 - 46. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. T. Brown, P. C. Davis, R. Lambert, L. Hsu, K. Hopkins, and J. Eckman Neurocognitive Functioning and Magnetic Resonance Imaging in Children With Sickle Cell Disease J. Pediatr. Psychol., October 1, 2000; 25(7): 503 - 513. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Styles, C. Hoppe, W. Klitz, E. Vichinsky, B. Lubin, and E. Trachtenberg Evidence for HLA-related susceptibility for stroke in children with sickle cell disease Blood, June 1, 2000; 95(11): 3562 - 3567. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. J. Kirkham, M. Prengler, D. K.M. Hewes, and V. Ganesan Risk Factors for Arterial Ischemic Stroke in Children J Child Neurol, May 1, 2000; 15(5): 299 - 307. [Abstract] [PDF]
|
|
