Skip to main content
Top
Published in: Child's Nervous System 7/2011

01-07-2011 | Review Paper

Current concepts in the management of stroke in children with sickle cell disease

Authors: M. S. Islam, P. Anoop

Published in: Child's Nervous System | Issue 7/2011

Login to get access

Abstract

Stroke is the most significant complication of sickle cell disease (SCD) in children with the potential for major morbidity and mortality. The recent two decades have witnessed tremendous advancements in understanding the pathophysiology of stroke, risk stratification of children and the role of timely preventative interventions. The aetiopathogenesis, types of stroke and specific risk factors are reviewed here with special emphasis on the role of transcranial Doppler ultrasonogram in the early identification of at-risk children. Published studies on primary and secondary prevention of stroke in children with SCD are analysed with respect to the levels of evidence, in favour of preventative and therapeutic strategies. The roles of the neurologist and the neurosurgeon are highlighted.
Literature
1.
go back to reference Herrick JB (1910) Peculiar elongated and sickle-shaped red corpuscles in a case of severe anemia. Arch Intern Med 6:517–521 Herrick JB (1910) Peculiar elongated and sickle-shaped red corpuscles in a case of severe anemia. Arch Intern Med 6:517–521
2.
go back to reference Ingram VM (1957) Gene mutations in human haemoglobin: the chemical difference between normal and sickle cell haemoglobin. Nature 180(4581):326–328PubMedCrossRef Ingram VM (1957) Gene mutations in human haemoglobin: the chemical difference between normal and sickle cell haemoglobin. Nature 180(4581):326–328PubMedCrossRef
4.
go back to reference Ohene-Frempong K, Weiner SJ, Sleeper LA, Miller ST, Embury S, Moohr JW et al (1998) Cerebrovascular accidents in sickle cell disease: rates and risk factors. Blood 91(1):288–294PubMed Ohene-Frempong K, Weiner SJ, Sleeper LA, Miller ST, Embury S, Moohr JW et al (1998) Cerebrovascular accidents in sickle cell disease: rates and risk factors. Blood 91(1):288–294PubMed
5.
go back to reference Broderick J, Talbot GT, Prenger E, Leach A, Brott T (1993) Stroke in children within a major metropolitan area: the surprising importance of intracerebral hemorrhage. J Child Neurol 8(3):250–255PubMedCrossRef Broderick J, Talbot GT, Prenger E, Leach A, Brott T (1993) Stroke in children within a major metropolitan area: the surprising importance of intracerebral hemorrhage. J Child Neurol 8(3):250–255PubMedCrossRef
6.
go back to reference Adams RJ, McKie VC, Carl EM, Nichols FT, Perry R, Brock K et al (1997) Long-term stroke risk in children with sickle cell disease screened with transcranial Doppler. Ann Neurol 42(5):699–704PubMedCrossRef Adams RJ, McKie VC, Carl EM, Nichols FT, Perry R, Brock K et al (1997) Long-term stroke risk in children with sickle cell disease screened with transcranial Doppler. Ann Neurol 42(5):699–704PubMedCrossRef
7.
go back to reference Switzer JA, Hess DC, Nichols FT, Adams RJ (2006) Pathophysiology and treatment of stroke in sickle-cell disease: present and future. Lancet Neurol 5(6):501–512PubMedCrossRef Switzer JA, Hess DC, Nichols FT, Adams RJ (2006) Pathophysiology and treatment of stroke in sickle-cell disease: present and future. Lancet Neurol 5(6):501–512PubMedCrossRef
8.
go back to reference Pegelow CH, Macklin EA, Moser FG, Wang WC, Bello JA, Miller ST (2002) Longitudinal changes in brain magnetic resonance imaging findings in children with sickle cell disease. Blood 99(8):3014–3018PubMedCrossRef Pegelow CH, Macklin EA, Moser FG, Wang WC, Bello JA, Miller ST (2002) Longitudinal changes in brain magnetic resonance imaging findings in children with sickle cell disease. Blood 99(8):3014–3018PubMedCrossRef
9.
go back to reference Merkel KH, Ginsberg PL, Parker JC Jr, Post MJ (1978) Cerebrovascular disease in sickle cell anemia: a clinical, pathological and radiological correlation. Stroke 9(1):45–52PubMed Merkel KH, Ginsberg PL, Parker JC Jr, Post MJ (1978) Cerebrovascular disease in sickle cell anemia: a clinical, pathological and radiological correlation. Stroke 9(1):45–52PubMed
10.
go back to reference Hsu LL, Miller ST, Wright E, Kutlar A, McKie V, Wang W et al (2003) Alpha Thalassemia is associated with decreased risk of abnormal transcranial Doppler ultrasonography in children with sickle cell anemia. J Pediatr Hematol Oncol 25(8):622–628PubMedCrossRef Hsu LL, Miller ST, Wright E, Kutlar A, McKie V, Wang W et al (2003) Alpha Thalassemia is associated with decreased risk of abnormal transcranial Doppler ultrasonography in children with sickle cell anemia. J Pediatr Hematol Oncol 25(8):622–628PubMedCrossRef
11.
go back to reference Kirkham FJ (2007) Therapy insight: stroke risk and its management in patients with sickle cell disease. Nat Clin Pract Neurol 3(5):264–278PubMedCrossRef Kirkham FJ (2007) Therapy insight: stroke risk and its management in patients with sickle cell disease. Nat Clin Pract Neurol 3(5):264–278PubMedCrossRef
12.
go back to reference Strouse JJ, Hulbert ML, DeBaun MR, Jordan LC, Casella JF (2006) Primary hemorrhagic stroke in children with sickle cell disease is associated with recent transfusion and use of corticosteroids. Pediatrics 118(5):1916–1924PubMedCrossRef Strouse JJ, Hulbert ML, DeBaun MR, Jordan LC, Casella JF (2006) Primary hemorrhagic stroke in children with sickle cell disease is associated with recent transfusion and use of corticosteroids. Pediatrics 118(5):1916–1924PubMedCrossRef
13.
14.
go back to reference Wang W, Enos L, Gallagher D, Thompson R, Guarini L, Vichinsky E et al (2001) Neuropsychologic performance in school-aged children with sickle cell disease: a report from the Cooperative Study of Sickle Cell Disease. J Pediatr 139(3):391–397PubMedCrossRef Wang W, Enos L, Gallagher D, Thompson R, Guarini L, Vichinsky E et al (2001) Neuropsychologic performance in school-aged children with sickle cell disease: a report from the Cooperative Study of Sickle Cell Disease. J Pediatr 139(3):391–397PubMedCrossRef
15.
go back to reference Schatz J, White DA, Moinuddin A, Armstrong M, DeBaun MR (2002) Lesion burden and cognitive morbidity in children with sickle cell disease. J Child Neurol 17(12):891–895PubMedCrossRef Schatz J, White DA, Moinuddin A, Armstrong M, DeBaun MR (2002) Lesion burden and cognitive morbidity in children with sickle cell disease. J Child Neurol 17(12):891–895PubMedCrossRef
16.
go back to reference Miller ST, Macklin EA, Pegelow CH, Kinney TR, Sleeper LA, Bello JA et al (2001) Silent infarction as a risk factor for overt stroke in children with sickle cell anemia: a report from the Cooperative Study of Sickle Cell Disease. J Pediatr 139(3):385–390PubMedCrossRef Miller ST, Macklin EA, Pegelow CH, Kinney TR, Sleeper LA, Bello JA et al (2001) Silent infarction as a risk factor for overt stroke in children with sickle cell anemia: a report from the Cooperative Study of Sickle Cell Disease. J Pediatr 139(3):385–390PubMedCrossRef
17.
go back to reference Wilimas J, Goff JR, Anderson HR Jr, Langston JW, Thompson E (1980) Efficacy of transfusion therapy for one to two years in patients with sickle cell disease and cerebrovascular accidents. J Pediatr 96(2):205–208PubMedCrossRef Wilimas J, Goff JR, Anderson HR Jr, Langston JW, Thompson E (1980) Efficacy of transfusion therapy for one to two years in patients with sickle cell disease and cerebrovascular accidents. J Pediatr 96(2):205–208PubMedCrossRef
18.
go back to reference Russell MO, Goldberg HI, Hodson A, Kim HC, Halus J, Reivich M, Schwartz E (1984) Effect of transfusion therapy on arteriographic abnormalities and on recurrence of stroke in sickle cell disease. Blood 63(1):162–169PubMed Russell MO, Goldberg HI, Hodson A, Kim HC, Halus J, Reivich M, Schwartz E (1984) Effect of transfusion therapy on arteriographic abnormalities and on recurrence of stroke in sickle cell disease. Blood 63(1):162–169PubMed
19.
go back to reference Wang WC, Kovnar EH, Tonkin IL, Mulhern RK, Langston JW, Day SW et al (1991) High risk of recurrent stroke after discontinuance of five to twelve years of transfusion therapy in patients with sickle cell disease. J Pediatr 118(3):377–382PubMedCrossRef Wang WC, Kovnar EH, Tonkin IL, Mulhern RK, Langston JW, Day SW et al (1991) High risk of recurrent stroke after discontinuance of five to twelve years of transfusion therapy in patients with sickle cell disease. J Pediatr 118(3):377–382PubMedCrossRef
20.
go back to reference Cohen AR, Martin MB, Silber JH, Kim HC, Ohene-Frempong K, Schwartz E (1992) A modified transfusion program for prevention of stroke in sickle cell disease. Blood 79(7):1657–1661PubMed Cohen AR, Martin MB, Silber JH, Kim HC, Ohene-Frempong K, Schwartz E (1992) A modified transfusion program for prevention of stroke in sickle cell disease. Blood 79(7):1657–1661PubMed
21.
go back to reference Adams RJ, McKie VC, Hsu L, Files B, Vichinsky E, Pegelow C et al (1998) Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med 339(1):5–11PubMedCrossRef Adams RJ, McKie VC, Hsu L, Files B, Vichinsky E, Pegelow C et al (1998) Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med 339(1):5–11PubMedCrossRef
22.
go back to reference Adams RJ, Brambilla D, Optimizing Primary Stroke Prevention in Sickle Cell Anemia (STOP 2) Trial Investigators (2005) Discontinuing prophylactic transfusions used to prevent stroke in sickle cell disease. N Engl J Med 353(26):2769–2778PubMedCrossRef Adams RJ, Brambilla D, Optimizing Primary Stroke Prevention in Sickle Cell Anemia (STOP 2) Trial Investigators (2005) Discontinuing prophylactic transfusions used to prevent stroke in sickle cell disease. N Engl J Med 353(26):2769–2778PubMedCrossRef
23.
go back to reference Casella JF, King AA, Barton B, White DA, Noetzel MJ, Ichord RN (2010) Design of the silent cerebral infarct transfusion (SIT) trial. Pediatr Hematol Oncol 27(2):69–89PubMedCrossRef Casella JF, King AA, Barton B, White DA, Noetzel MJ, Ichord RN (2010) Design of the silent cerebral infarct transfusion (SIT) trial. Pediatr Hematol Oncol 27(2):69–89PubMedCrossRef
24.
go back to reference Ware RE, Zimmerman SA, Schultz WH (1999) Hydroxyurea as an alternative to blood transfusions for the prevention of recurrent stroke in children with sickle cell disease. Blood 94(9):3022–3026PubMed Ware RE, Zimmerman SA, Schultz WH (1999) Hydroxyurea as an alternative to blood transfusions for the prevention of recurrent stroke in children with sickle cell disease. Blood 94(9):3022–3026PubMed
25.
go back to reference Sumoza A, de Bisotti R, Sumoza D, Fairbanks V (2002) Hydroxyurea (HU) for prevention of recurrent stroke in sickle cell anemia (SCA). Am J Hematol 71(3):161–165PubMedCrossRef Sumoza A, de Bisotti R, Sumoza D, Fairbanks V (2002) Hydroxyurea (HU) for prevention of recurrent stroke in sickle cell anemia (SCA). Am J Hematol 71(3):161–165PubMedCrossRef
26.
go back to reference Gulbis B, Haberman D, Dufour D, Christophe C, Vermylen C, Kagambega F et al (2005) Hydroxyurea for sickle cell disease in children and for prevention of cerebrovascular events: the Belgian experience. Blood 105(7):2685–2690PubMedCrossRef Gulbis B, Haberman D, Dufour D, Christophe C, Vermylen C, Kagambega F et al (2005) Hydroxyurea for sickle cell disease in children and for prevention of cerebrovascular events: the Belgian experience. Blood 105(7):2685–2690PubMedCrossRef
27.
go back to reference Ware RE, Zimmerman SA, Sylvestre PB, Mortier NA, Davis JS, Treem WR et al (2004) Prevention of secondary stroke and resolution of transfusional iron overload in children with sickle cell anemia using hydroxyurea and phlebotomy. J Pediatr 145(3):346–352PubMedCrossRef Ware RE, Zimmerman SA, Sylvestre PB, Mortier NA, Davis JS, Treem WR et al (2004) Prevention of secondary stroke and resolution of transfusional iron overload in children with sickle cell anemia using hydroxyurea and phlebotomy. J Pediatr 145(3):346–352PubMedCrossRef
29.
go back to reference Walters MC, Patience M, Leisenring W, Eckman JR, Scott JP, Mentzer WC et al (1996) Bone marrow transplantation for sickle cell disease. N Engl J Med 335(6):369–376PubMedCrossRef Walters MC, Patience M, Leisenring W, Eckman JR, Scott JP, Mentzer WC et al (1996) Bone marrow transplantation for sickle cell disease. N Engl J Med 335(6):369–376PubMedCrossRef
30.
go back to reference Nietert PJ, Abboud MR, Silverstein MD, Jackson SM (2000) Bone marrow transplantation versus periodic prophylactic blood transfusion in sickle cell patients at high risk of ischemic stroke: a decision analysis. Blood 95(10):3057–3064PubMed Nietert PJ, Abboud MR, Silverstein MD, Jackson SM (2000) Bone marrow transplantation versus periodic prophylactic blood transfusion in sickle cell patients at high risk of ischemic stroke: a decision analysis. Blood 95(10):3057–3064PubMed
31.
go back to reference Walters MC, Storb R, Patience M, Leisenring W, Taylor T, Sanders JE et al (2000) Impact of bone marrow transplantation for symptomatic sickle cell disease: an interim report. Multicenter investigation of bone marrow transplantation for sickle cell disease. Blood 95(6):1918–1924PubMed Walters MC, Storb R, Patience M, Leisenring W, Taylor T, Sanders JE et al (2000) Impact of bone marrow transplantation for symptomatic sickle cell disease: an interim report. Multicenter investigation of bone marrow transplantation for sickle cell disease. Blood 95(6):1918–1924PubMed
32.
go back to reference Steen RG, Helton KJ, Horwitz EM, Benaim E, Thompson S, Bowman LC et al (2001) Improved cerebrovascular patency following therapy in patients with sickle cell disease: initial results in 4 patients who received HLA-identical hematopoietic stem cell allografts. Ann Neurol 49(2):222–229PubMedCrossRef Steen RG, Helton KJ, Horwitz EM, Benaim E, Thompson S, Bowman LC et al (2001) Improved cerebrovascular patency following therapy in patients with sickle cell disease: initial results in 4 patients who received HLA-identical hematopoietic stem cell allografts. Ann Neurol 49(2):222–229PubMedCrossRef
34.
go back to reference Adams RJ, McKie VC, Brambilla D, Carl E, Gallagher D, Nichols FT et al (1998) Stroke prevention trial in sickle cell anemia. Control Clin Trials 19(1):110–129PubMedCrossRef Adams RJ, McKie VC, Brambilla D, Carl E, Gallagher D, Nichols FT et al (1998) Stroke prevention trial in sickle cell anemia. Control Clin Trials 19(1):110–129PubMedCrossRef
36.
go back to reference Charache S, Terrin ML, Moore RD, Dover GJ, Barton FB, Eckert SV et al (1995) Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia Investigators of the Multicenter Study of Hydroxyurea in Sickle Cell Anemia. N Engl J Med 332(20):1317–1322PubMedCrossRef Charache S, Terrin ML, Moore RD, Dover GJ, Barton FB, Eckert SV et al (1995) Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia Investigators of the Multicenter Study of Hydroxyurea in Sickle Cell Anemia. N Engl J Med 332(20):1317–1322PubMedCrossRef
37.
go back to reference Charache S, Barton FB, Moore RD, Terrin ML, Steinberg MH, Dover GJ et al (1996) Hydroxyurea and sickle cell anemia. Clinical utility of a myelosuppressive "switching" agent: The Multicenter Study of Hydroxyurea in Sickle Cell Anemia. Medicine (Baltimore) 75(6):300–326CrossRef Charache S, Barton FB, Moore RD, Terrin ML, Steinberg MH, Dover GJ et al (1996) Hydroxyurea and sickle cell anemia. Clinical utility of a myelosuppressive "switching" agent: The Multicenter Study of Hydroxyurea in Sickle Cell Anemia. Medicine (Baltimore) 75(6):300–326CrossRef
38.
go back to reference Adragna NC, Fonseca P, Lauf PK (1994) Hydroxyurea affects cell morphology, cation transport and red blood cell adhesion on cultured vascular endothelial cells. Blood 83(2):553–560PubMed Adragna NC, Fonseca P, Lauf PK (1994) Hydroxyurea affects cell morphology, cation transport and red blood cell adhesion on cultured vascular endothelial cells. Blood 83(2):553–560PubMed
39.
go back to reference McQuaker IG, Jaspan T, McConachie NS, Dolan G (1999) Coil embolization of cerebral aneurysms in patients with sickling disorders. Br J Haematol 106(2):388–390PubMedCrossRef McQuaker IG, Jaspan T, McConachie NS, Dolan G (1999) Coil embolization of cerebral aneurysms in patients with sickling disorders. Br J Haematol 106(2):388–390PubMedCrossRef
40.
go back to reference Woodard P, Helton KJ, Khan RB, Hale GA, Phipps S, Wang W et al (2005) Brain parenchymal damage after haematopoietic stem cell transplantation for severe sickle cell disease. Br J Haematol 129(4):550–552PubMedCrossRef Woodard P, Helton KJ, Khan RB, Hale GA, Phipps S, Wang W et al (2005) Brain parenchymal damage after haematopoietic stem cell transplantation for severe sickle cell disease. Br J Haematol 129(4):550–552PubMedCrossRef
Metadata
Title
Current concepts in the management of stroke in children with sickle cell disease
Authors
M. S. Islam
P. Anoop
Publication date
01-07-2011
Publisher
Springer-Verlag
Published in
Child's Nervous System / Issue 7/2011
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-011-1394-0

Other articles of this Issue 7/2011

Child's Nervous System 7/2011 Go to the issue