Transcranial doppler and magnetic resonance in Tanzanian children with sickle cell disease

Abstract

Background and Purpose: We determined prevalences of neurological complications, vascular abnormality and infarction in Tanzanian children with Sickle Cell Disease (SCD). Methods: Children with SCD were consecutively enrolled for Transcranial Doppler (TCD); those with slightly elevated (>150cm/s), low (<50cm/s) or absent cerebral blood flow velocity (CBFv) were invited for brain MRI and MRA. Results: Of 200 children (median age 9; range 6-13 years; 105 (52.5%) 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 haemoglobin level, but not higher indirect bilirubin level. On multivariable analysis CBFv>150cm/s was associated with frequent painful crises and low haemoglobin level. Absent/low CBFv was associated with low hemoglobin level and history of unilateral weakness. In 49/67 children with low/absent/elevated TCD undergoing MRI, 43% had infarction while 24/48 (50%) MRAs were abnormal. One had hemorrhagic infarction; none had microbleeds. Posterior circulation infarcts occurred in 14%. Of 11 children with previous seizure undergoing MRI, 10 (91%) had infarction (5 silent) compared with 11/38 (29%) of the remainder (p=0.003). Of 7 children with clinical stroke, 2 had recurrent stroke and 3 died; 4/5 had absent CBFv. Of 193 without stroke, one died and one had a stroke; both had absent CBFv.Conclusions: In one third of Tanzanian children with SCD, CBFv is outside the normal range, associated with frequent painful crises and low hemoglobin level but not hemolysis. Half have abnormal MRA. African children with SCD should be evaluated with TCD; those with low/absent/elevated CBFv should undergo MRI/MRA.

More information

Identifiers

ORCID for Fenella J. Kirkham: orcid.org/0000-0002-2443-7958

Catalogue record

Export record

Altmetrics