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Transcranial Doppler and Magnetic Resonance in Tanzanian Children With Sickle Cell Disease.
Kija, Edward N; Saunders, Dawn E; Munubhi, Emmanuel; Darekar, Angela; Barker, Simon; Cox, Timothy C S; Mango, Mechris; Soka, Deogratias; Komba, Joyce; Nkya, Deogratias A; Cox, Sharon E; Kirkham, Fenella J; Newton, Charles R J C.
Afiliação
  • Kija EN; From the Muhimbili Wellcome Programme, Dar es Salaam, Tanzania (E.N.K., E.M., D.S., J.K., D.A.N., S.E.C., C.R.J.C.N.).
  • Saunders DE; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (E.N.K., M.M., D.S., C.R.J.C.N.).
  • Munubhi E; Developmental Neurosciences and Biomedical Research Unit, UCL Great Ormond Street Institute of Child Health, United Kingdom (D.E.S., T.C.S.C., F.J.K.).
  • Darekar A; From the Muhimbili Wellcome Programme, Dar es Salaam, Tanzania (E.N.K., E.M., D.S., J.K., D.A.N., S.E.C., C.R.J.C.N.).
  • Barker S; University Hospital Southampton, United Kingdom (A.D., S.B., F.J.K.).
  • Cox TCS; University Hospital Southampton, United Kingdom (A.D., S.B., F.J.K.).
  • Mango M; Developmental Neurosciences and Biomedical Research Unit, UCL Great Ormond Street Institute of Child Health, United Kingdom (D.E.S., T.C.S.C., F.J.K.).
  • Soka D; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (E.N.K., M.M., D.S., C.R.J.C.N.).
  • Komba J; From the Muhimbili Wellcome Programme, Dar es Salaam, Tanzania (E.N.K., E.M., D.S., J.K., D.A.N., S.E.C., C.R.J.C.N.).
  • Nkya DA; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (E.N.K., M.M., D.S., C.R.J.C.N.).
  • Cox SE; From the Muhimbili Wellcome Programme, Dar es Salaam, Tanzania (E.N.K., E.M., D.S., J.K., D.A.N., S.E.C., C.R.J.C.N.).
  • Kirkham FJ; From the Muhimbili Wellcome Programme, Dar es Salaam, Tanzania (E.N.K., E.M., D.S., J.K., D.A.N., S.E.C., C.R.J.C.N.).
  • Newton CRJC; From the Muhimbili Wellcome Programme, Dar es Salaam, Tanzania (E.N.K., E.M., D.S., J.K., D.A.N., S.E.C., C.R.J.C.N.).
Stroke ; 50(7): 1719-1726, 2019 07.
Article em En | MEDLINE | ID: mdl-31195937
Background and Purpose- We determined prevalences of neurological complications, vascular abnormality, and infarction in Tanzanian children with sickle cell disease. Methods- Children with sickle cell disease were consecutively enrolled for transcranial Doppler; those with slightly elevated (>150 cm/s), low (<50 cm/s) or absent cerebral blood flow velocity (CBFv) were invited for brain magnetic resonance imaging and magnetic resonance angiography. Results- Of 200 children (median age 9; range 6-13 years; 105 [2.5%] boys), 21 (11%) and 15 (8%) had previous seizures and unilateral weakness, respectively. Twenty-eight (14%) had elevated and 39 (20%) had low/absent CBFv, all associated with lower hemoglobin level, but not higher indirect bilirubin level. On multivariable analysis, CBFv>150 cm/s was associated with frequent painful crises and low hemoglobin level. Absent/low CBFv was associated with low hemoglobin level and history of unilateral weakness. In 49 out of 67 children with low/absent/elevated transcranial Doppler undergoing magnetic resonance imaging, 43% had infarction, whereas 24 out of 48 (50%) magnetic resonance angiographies were abnormal. One had hemorrhagic infarction; none had microbleeds. Posterior circulation infarcts occurred in 14%. Of 11 children with previous seizure undergoing magnetic resonance imaging, 10 (91%) had infarction (5 silent) compared with 11 out of 38 (29%) of the remainder ( P=0.003). Of 7 children with clinical stroke, 2 had recurrent stroke and 3 died; 4 out of 5 had absent CBFv. Of 193 without stroke, 1 died and 1 had a stroke; both had absent CBFv. Conclusions- In one-third of Tanzanian children with sickle cell disease, CBFv is outside the normal range, associated with frequent painful crises and low hemoglobin level, but not hemolysis. Half have abnormal magnetic resonance angiography. African children with sickle cell disease should be evaluated with transcranial Doppler; those with low/absent/elevated CBFv should undergo magnetic resonance imaging/magnetic resonance angiography.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Acidente Vascular Cerebral / Anemia Falciforme Tipo de estudo: Etiology_studies / Risk_factors_studies Limite: Adolescent / Child / Female / Humans / Male País/Região como assunto: Africa Idioma: En Revista: Stroke Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Acidente Vascular Cerebral / Anemia Falciforme Tipo de estudo: Etiology_studies / Risk_factors_studies Limite: Adolescent / Child / Female / Humans / Male País/Região como assunto: Africa Idioma: En Revista: Stroke Ano de publicação: 2019 Tipo de documento: Article