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

Transcranial doppler and magnetic resonance in Tanzanian children with sickle cell disease
Transcranial doppler and magnetic resonance in Tanzanian children with sickle cell disease
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.
0039-2499
Kija, Edward
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Saunders, Dawn E.
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Darekar, Angela
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Cox, Sharon E.
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Manubhi, Emmanuel
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Soka, Deogratias
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Barker, Simon
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Mango, Mechris
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Komba, Joyce
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Cox, Timothy C.S.
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Nkya, Deogratias A.
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Kirkham, Fenella
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Newton, Charles
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Kija, Edward
a6cacc30-76df-4d48-9d75-bcbf3d7c8ee5
Saunders, Dawn E.
0ceef8e6-dfd8-4c92-acf5-87543f449367
Darekar, Angela
62e6b511-a358-4e5d-a4ea-03890ba7c2c7
Cox, Sharon E.
3eb867f2-b68d-40a5-b852-e01bd6e37829
Manubhi, Emmanuel
63e78ebb-3e82-42ec-b003-b2f679258522
Soka, Deogratias
80b7ac9f-b909-48a3-b975-1afc7c739202
Barker, Simon
4ec1e930-ec52-4154-a7aa-537ff4785607
Mango, Mechris
ef7f097e-0a1a-4715-ab26-c424b2466af1
Komba, Joyce
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Cox, Timothy C.S.
d20ae762-6fed-4c1d-ab79-db8145c29ade
Nkya, Deogratias A.
9ed557cf-189d-4425-b9fb-86daa91b6797
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Newton, Charles
782d550e-56c1-4c8e-82d0-a0b7280b09ee

Kija, Edward, Saunders, Dawn E., Darekar, Angela, Cox, Sharon E., Manubhi, Emmanuel, Soka, Deogratias, Barker, Simon, Mango, Mechris, Komba, Joyce, Cox, Timothy C.S., Nkya, Deogratias A., Kirkham, Fenella and Newton, Charles (2019) Transcranial doppler and magnetic resonance in Tanzanian children with sickle cell disease. Stroke. (In Press)

Record type: Article

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.

Text
Kija_MRI_in_Tanzanians_with_SCD_Stroke_resubmission_Jan_2019_clean - Accepted Manuscript
Restricted to Repository staff only until 4 October 2019.
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Accepted/In Press date: 4 April 2019

Identifiers

Local EPrints ID: 430259
URI: https://eprints.soton.ac.uk/id/eprint/430259
ISSN: 0039-2499
PURE UUID: 9236a63c-7afd-43d1-baa4-8930e696f8e9

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Date deposited: 23 Apr 2019 16:30
Last modified: 23 Apr 2019 16:30

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Contributors

Author: Edward Kija
Author: Dawn E. Saunders
Author: Angela Darekar
Author: Sharon E. Cox
Author: Emmanuel Manubhi
Author: Deogratias Soka
Author: Simon Barker
Author: Mechris Mango
Author: Joyce Komba
Author: Timothy C.S. Cox
Author: Deogratias A. Nkya
Author: Fenella Kirkham
Author: Charles Newton

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