Silent Cerebral Infarcts and Retinal changes in patients with Sickle cell Disease
Abstract
Background: CNS Complications of SCD include headache, seizures, cerebral venous thrombosis, and strokes. 11% and 20% of children with sickle cell anaemia will have overt and silent strokes respectively before their 18th birthday. 14-20% of SCD patients will develop Sickle cell Retinopathy.
Aim of study: To look for SCI and Retinal changes in SCD children. Design- Prospective Cross sectional study. Participants- Below 16 yrs in a tertiary care hospital MYH/CNBC Indore, MP.
Method: 40 children with SCD < 16 years admitted to Department of Paediatrics, MYH / CNBC Hospital, Indore, from December 2014 to October 2015 were selected and underwent MRI evaluation of brain and fundus examination.
Result: Only 6 (15%) had presence of AV tortuosity with dialatation and 4 (10%) had presence of SCI (p>0.05) out of 40. All patients with SCI had presence of AV tortuosity (p=0.001).
Statistical Analysis: Kruskal wallis test was applied.
Conclusion: 40 children with SCD below the age of 16 years were included, 4(10%) had SCI and 6 (15%) had AV tortuosity and dilatation of retinal vessels. Asymptomatic children of SCD with unanticipated silent infarcts are highly predictive of subsequent clinical stroke and progressive silent infarction. So, these patients should receive frequent blood transfusion to decrease the level of HbS and Hydroxyurea to increase the HbF levels to prevent further subsequent clinical stroke. Also these children should undergo regular ophthalmic checkup for retinal changes and evaluation by MRI Brain for early detection of cerebral infarcts to prevent future occurrence of stroke.
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References
2. Nathan and Oskis Haematology of Infancy and childhood 7th edition- Chapter 19th Sickle cell disease- Acute CNS events pg no. 967- 969.
3. Nathan and Oskis Haematology of Infancy and childhood 7th edition , Chapter 19th Sickle cell disease -Eyes- pg no. 976- 977. [PubMed]
4. Talbot JF, Bird AC, Serjeant GR, Hayes RJ. Sickle cell retinopathy in young children in Jamaica. Br J Ophthalmol. 1982 Mar;66(3):149-54. [PubMed]
5. UV Eruchalu et al (Ocular findings in children with severe clinical symptoms of homozygous sickle cell anemia in Kaduna,Nigeria) published in West African journal of Medicine Volume 25 No.2 (2006)
6. Thomas R. Kinney et al (Silent Cerebral Infarcts in Sickle Cell Anemia: A Risk Factor Analysis Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina) published in American Academy of Paediatrics vol. 103 no. 3 640-645
7. R. Grant Steen et al(Brain Imaging Findings in Pediatric Patients with Sickle Cell Disease at St Jude Children’s Research Hosp,LauderdaleSt, Memphis published in RSNA Radiology july 2003, Volume 228, Issue 1.
8. Quinn et al (Acute Silent Cerebral Ischemic Events in Children with Sickle Cell Anemia at tertiary care centers specializing in the treatment of children with Sickle cell anemia in the United States,England, and France.) Published in JAMA Neurol. 2013 January ; 70(1): 58–65. doi:10.1001/jamaneurol.2013.576
Copyright (c) 2016 Author (s). Published by Siddharth Health Research and Social Welfare Society
This work is licensed under a Creative Commons Attribution 4.0 International License.
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