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

Scott T. Miller, Eric A. Macklin, Charles H. Pegelow, Thomas R. Kinney, Lynn A. Sleeper, Jacqueline A. Bello, L. Dana DeWitt, Dianne M. Gallagher, Ludovico Guarini, Franklin G. Moser, Kwaku Ohene-Frempong, Nelson Sanchez, Elliott P. Vichinsky, Winfred C. Wang, Doris L. Wethers, Donald P. Younkin, Robert A. Zimmerman, Michael R. DeBaun

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Abstract

Objective: To determine whether children with homozygous sickle cell anemia (SCD) who have silent infarcts on magnetic resonance imaging (MRI) of the brain are at increased risk for overt stroke. Methods: We selected patients with homozygous SCD who (1) enrolled in the Cooperative Study of Sickle Cell Disease (CSSCD) before age 6 months, (2) had at least 1 study-mandated brain MRI at age 6 years or older, and (3) had no overt stroke before a first MRI. MRI results and clinical and laboratory parameters were tested as predictors of stroke. Results: Among 248 eligible patients, mean age at first MRI was 8.3 ± 1.9 years, and mean follow-up after baseline MRI was 5.2 ± 2.2 years. Five (8.1%) of 62 patients with silent infarct had strokes compared with 1 (0.5%) of 186 patients without prior silent infarct; incidence per 100 patient-years of follow-up was increased 14-fold (1.45 per 100 patient-years vs 0.11 per 100 patient-years, P = .006). Of several clinical and laboratory parameters examined, silent infarct was the strongest independent predictor of stroke (hazard ratio = 7.2, P = .027). Conclusions: Silent infarct identified at age 6 years or older is associated with increased stroke risk.

Original languageEnglish (US)
Pages (from-to)385-390
Number of pages6
JournalJournal of Pediatrics
Volume139
Issue number3
DOIs
StatePublished - Jan 1 2001

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ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Miller, S. T., Macklin, E. A., Pegelow, C. H., Kinney, T. R., Sleeper, L. A., Bello, J. A., DeWitt, L. D., Gallagher, D. M., Guarini, L., Moser, F. G., Ohene-Frempong, K., Sanchez, N., Vichinsky, E. P., Wang, W. C., Wethers, D. L., Younkin, D. P., Zimmerman, R. A., & DeBaun, M. R. (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. Journal of Pediatrics, 139(3), 385-390. https://doi.org/10.1067/mpd.2001.117580