Silent infarcts in children with sickle cell anemia and abnormal cerebral artery velocity

Charles H. Pegelow, Winfred Wang, Suzanne Granger, Lewis L. Hsu, Elliott Vichinsky, Franklin G. Moser, Jacqueline A. Bello, Robert A. Zimmerman, Robert J. Adams, Donald Brambilla

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Background: A substantial minority of neurologically normal children with sickle cell disease have lesions consistent with cerebral infarction as seen on magnetic resonance imaging (MRI). Objectives: To determine if transfusion therapy affects the rate at which silent infarcts develop and to evaluate the contribution of MRI of the brain to stroke prediction by transcranial Doppler (TCD) ultrasonography. Study Design: Children with elevated TCD ultrasonographic velocity were randomized to receive long-term transfusion therapy or standard care. Magnetic resonance imaging of the brain was obtained at randomization, annually, and with clinical neurologic events. The risk for new silent lesions and/or stroke was compared for each treatment arm. Results: Among the 37% of subjects with silent infarcts, those receiving standard care were significantly more likely to develop new silent lesions or stroke than were those who received transfusion therapy. For subjects receiving standard care, those with lesions at baseline were significantly more likely to develop stroke or new silent lesions than those whose MRI studies showed no abnormality. Conclusions: Transfusion therapy lowers the risk for new silent infarct or stroke for children having both abnormal TCD ultrasonographic velocity and silent infarct. However, those with both abnormalities who are not provided transfusion therapy are at higher risk for developing a new silent infarct or stroke than are those whose initial MRI showed no abnormality. The finding of a silent infarct reinforces the need for TCD ultrasonographic screening and consideration of transfusion therapy if the abnormalities are seen. Similarly, elevated TCD ultrasonographic velocity warrants MRI of the brain because children with both abnormalities seem to be at increased risk for developing new silent infarct or stroke.

Original languageEnglish (US)
Pages (from-to)2017-2021
Number of pages5
JournalArchives of Neurology
Volume58
Issue number12
StatePublished - Dec 2001

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Cerebral Arteries
Sickle Cell Anemia
Stroke
Magnetic Resonance Imaging
Therapeutics
Brain
Doppler Transcranial Ultrasonography
Cerebral Infarction
Random Allocation
Anemia
Cells
Sickles
Nervous System
Therapy
Transfusion
Lesion

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Pegelow, C. H., Wang, W., Granger, S., Hsu, L. L., Vichinsky, E., Moser, F. G., ... Brambilla, D. (2001). Silent infarcts in children with sickle cell anemia and abnormal cerebral artery velocity. Archives of Neurology, 58(12), 2017-2021.

Silent infarcts in children with sickle cell anemia and abnormal cerebral artery velocity. / Pegelow, Charles H.; Wang, Winfred; Granger, Suzanne; Hsu, Lewis L.; Vichinsky, Elliott; Moser, Franklin G.; Bello, Jacqueline A.; Zimmerman, Robert A.; Adams, Robert J.; Brambilla, Donald.

In: Archives of Neurology, Vol. 58, No. 12, 12.2001, p. 2017-2021.

Research output: Contribution to journalArticle

Pegelow, CH, Wang, W, Granger, S, Hsu, LL, Vichinsky, E, Moser, FG, Bello, JA, Zimmerman, RA, Adams, RJ & Brambilla, D 2001, 'Silent infarcts in children with sickle cell anemia and abnormal cerebral artery velocity', Archives of Neurology, vol. 58, no. 12, pp. 2017-2021.
Pegelow CH, Wang W, Granger S, Hsu LL, Vichinsky E, Moser FG et al. Silent infarcts in children with sickle cell anemia and abnormal cerebral artery velocity. Archives of Neurology. 2001 Dec;58(12):2017-2021.
Pegelow, Charles H. ; Wang, Winfred ; Granger, Suzanne ; Hsu, Lewis L. ; Vichinsky, Elliott ; Moser, Franklin G. ; Bello, Jacqueline A. ; Zimmerman, Robert A. ; Adams, Robert J. ; Brambilla, Donald. / Silent infarcts in children with sickle cell anemia and abnormal cerebral artery velocity. In: Archives of Neurology. 2001 ; Vol. 58, No. 12. pp. 2017-2021.
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AU - Moser, Franklin G.

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