Transcranial Doppler Ultrasound in Peninsular Arab Patients With Sickle Cell Disease

2018 ◽  
Vol 38 (1) ◽  
pp. 165-172 ◽  
Author(s):  
Adekunle Adekile ◽  
Meaad Hassan ◽  
Akram Asbeutah ◽  
Mohamed Al‐Hinai ◽  
Omar Trad ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Doppler Ultrasound ◽  
Sickle Cell ◽  
Transcranial Doppler ◽  
Transcranial Doppler Ultrasound ◽  
Cell Disease

Transcranial Doppler Ultrasound Velocity, Cerebral Vasculopathy, and Silent Infarcts In Sickle Cell Disease

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 269-269
Author(s):  
Peter M.K. de Blank ◽  
Daniel M Hayward ◽  
Robert Zimmerman, MD ◽  
Avrum Pollock ◽  
Janet L Kwiatkowski
Keyword(s):  
Magnetic Resonance ◽  
Sickle Cell Disease ◽  
Doppler Ultrasound ◽  
Sickle Cell ◽  
Cerebral Artery ◽  
Transcranial Doppler ◽  
Transcranial Doppler Ultrasound ◽  
Cell Disease ◽  
Increased Risk ◽  
The Mean

Abstract Abstract 269 Background: Approximately one-fourth of children with sickle cell disease (SCD), type SS, show evidence of cerebral ischemia on magnetic resonance imaging (MRI) without overt neurologic symptoms. Children with these silent infarcts have an increased risk of neuropsychological abnormalities and overt stroke. The pathophysiology of silent infarcts is unclear. Elevated transcranial Doppler ultrasound (TCD) velocities in the internal cerebral artery (ICA) and middle cerebral artery (MCA) are associated with an increased risk of overt stroke, but have not been associated previously with silent infarct. However, prior studies of silent infarcts failed to examine the association with anterior cerebral artery (ACA) vessel abnormalities, despite a predominantly frontal distribution of these infarcts. In addition, the relationship of magnetic resonance angiography (MRA) abnormalities to silent infarcts has not been extensively studied, although children with abnormal TCD velocity who also have stenosis or occlusion of vessels by MRA have the highest risk of overt stroke. We hypothesized that elevated ACA velocity and/or significant vasculopathy of the cerebral vessels demonstrated by MRA would be associated with a higher risk of silent stroke. Methods: A retrospective analysis of children followed at our Sickle Cell Center with SCD, type SS or Sb0-thalassemia was performed. Children with TCD (with ACA velocity) and brain MRI/A performed within a year of each other were included. TCD studies performed while on chronic transfusions were excluded. The last eligible MRI/TCD combination was used for patients who had multiple studies. Laboratory values obtained within a year of the MRI also were analyzed. Results: Of the 254 eligible subjects, 54% were male and the mean age was 10.6 ± 5.2 years. Silent infarcts were present in 78/254 (30.7%); the location was frontoparietal in 68%. The mean time-averaged mean of the maximal velocity (TAMMvel) of qualifying STOP vessels (MCA, bifurcation, and ICA) was 139±35cm/s, while the mean TAMMvel of the ACA was 117±34cm/s, which is 84% of the velocity of the other anterior vessels. As previously reported, TAMMvel inversely correlated with age (r=-0.40, p<0.0001) and hemoglobin concentration (r=-0.30, p<0.0001). There was no significant difference in TAMMvel in STOP qualifying vessels (MCA, bifurcation, DICA; 137cm/s vs. 145cm/s, p=0.08) among those with and without silent infarct. However, silent infarcts were associated with abnormal TAMMvel (≥200cm/s, 69/239 with normal/conditional vs. 9/15 with abnormal TAMMvel p=0.01) in these vessels. TAMMvel in the ACA was significantly higher (125 cm/s vs. 113 cm/s, p=0.004) in children with silent infarcts, and elevated ACA TAMMvel (≥170cm/s) was associated with silent infarcts (70/242 with normal vs. 8/12 with elevated velocity, p=0.006). No other single vessel velocity was significantly associated with silent infarct. Abnormal ICA/MCA TAMMvel was associated with stenosis of these vessels by MRA (p<0.001), and abnormal ACA velocities were associated with ACA stenosis by MRA (p<0.001). Further, stenosis by MRA in the ICA/MCA was associated with silent infarct (p<0.006) as were abnormalities of the ACA vessels (p=0.001). Conclusions: Unlike prior studies, we demonstrate a significant association between abnormal ICA/MCA velocity and silent infarcts. We also show an association between ACA velocity and silent infarct, which may in part be due to the predominantly frontoparietal distribution of these lesions. This, together with the association of MRA abnormalities of all three anterior vessels (ICA, MCA, ACA) with silent infarcts suggests a possible role of larger cerebral vessel vasculopathy in the pathophysiology of silent infarcts. This could be due to decreased distal blood flow related to the larger vessel narrowing, embolization of thrombus in larger vessels, or small vessel vasculopathy associated with larger vessel disease. However, mechanisms other than larger vessel vasculopathy are also likely to be involved given that silent infarcts occur in a substantial number of children without elevated TCD velocity or vasculopathy by MRA. Nonetheless, assessment of TCD velocity and MRA abnormalities may help provide information on risk assessment for CNS disease in children with SCD. Disclosures: No relevant conflicts of interest to declare.

PO12-TU-02 Transcranial Doppler ultrasound in sickle cell disease: an experience from Oman

2009 ◽  
Vol 285 ◽  
pp. S222-S223
Author(s):  
G.R. Gujjar ◽  
Z. Lamki ◽  
Y. Wali ◽  
A. AlAsmi ◽  
A. Pathare ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Doppler Ultrasound ◽  
Sickle Cell ◽  
Transcranial Doppler ◽  
Transcranial Doppler Ultrasound ◽  
Cell Disease

scholarly journals An Educational Study Promoting the Delivery of Transcranial Doppler Ultrasound Screening in Paediatric Sickle Cell Disease: A European Multi-Centre Perspective

2019 ◽  
Vol 9 (1) ◽  
pp. 44
Author(s):  
Baba P. D. Inusa ◽  
Laura Sainati ◽  
Corrina MacMahon ◽  
Raffaella Colombatti ◽  
Maddalena Casale ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Doppler Ultrasound ◽  
Sickle Cell ◽  
Transcranial Doppler ◽  
Stroke Risk ◽  
Transcranial Doppler Ultrasound ◽  
Ultrasound Screening ◽  
Cell Disease ◽  
Risk Distribution ◽  
The Impact

Background: Effective stroke prevention in sickle cell disease (SCD) is recommended for children with sickle cell anaemia. Effective implementation relies on the correct stratification of stroke risk using Transcranial Doppler Ultrasound (TCD), prior to committing children to long-term treatment with transfusion. Nevertheless, less than 50% of children with SCD in Europe receive annual TCD—one of the reasons being a lack of trained personnel. The present European multi-centre study was designed to promote the standardisation and delivery of effective screening. Methods: Fifty-five practitioners from differing professional backgrounds were recruited to the TCD training program. The impact of the training programme was evaluated in three European haematology clinics by comparing stroke risk classification and middle cerebral artery time-averaged maximum velocity (TAMMV) obtained from a cohort of 555 patients, before and after training. Results: 42% (23/55) of trainees successfully completed the program. The TAMMV, used to predict stroke risk at each Centre, demonstrated the highest values in Centre 3 (p < 0.0001) before training. The imaging-TCD TAMMV was also higher in Centre 3 (p < 0.001). Following training, the TAMMV showed closer agreement between centres for both imaging-TCD and non-imaging TCD. The stroke risk distribution of children at each centre varied significantly before training (p < 0.001), but improved after training (Fisher’s Exact: no treatment = 5.6, p = 0.41, treatment = 13.8, p < 0.01). The same consistency in stroke risk distribution following training was demonstrated with both non-imaging and imaging-TCD data. Conclusion: The attainment of competency in stroke screening using transcranial Doppler scanning (TCD) in sickle cell disease is more feasible for professionals with an ultrasound imaging background. A quality assurance (QA) system is required to ensure that standards are maintained. Further work is in progress to develop an achievable and reproducible QA program.

scholarly journals Silent Strokes May Be Involved in Neurocognitive Impairment in Children With Sickle Cell Disease

2021 ◽  
Author(s):  
Bruno Silva ◽  
Ândrea Ribeiro dos-Santos ◽  
Diana Oliveira Ribeiro ◽  
Tamara Tavares da Cruz ◽  
Ana Emília Vita Carvalho ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Transcranial Doppler ◽  
Transcranial Doppler Ultrasound ◽  
Neurological Complications ◽  
Cell Disease ◽  
Exact Test ◽  
Neurocognitive Impairments ◽  
Northern Brazil ◽  
Common Clinical Finding

Abstract Neurological complications are frequent occurrences in children and adolescents with sickle cell disease (SCD). This research has investigated the prevalence of neurovascular and neurocognitive impairments in 17 patients with SCD from Northern Brazil, with aged 6-16 years. Transcranial Doppler Ultrasound (TDU) examinations were performed on patients employing the STOP protocol as a risk score to predict stroke. Neuropsychological assessments were also performed: the Wechsler Intelligence Scale for Children - 4th Edition (WISC-IV). Fisher's Exact Test was used for statistical analyses (p ≤0.05) of the collected dataset. Frequent headaches were a common clinical finding, occurring in over 75% of the children. There were no alterations in cerebral hemodynamics on TDU for over 70% of the patients. In general, patients had below-average scores on most cognitive domains. There was a tendency for correlation between transcranial Doppler results and the WISC-IV indices of total Intelligence Quotient (p = 0.069) and Processing Speed Index (p = 0.082). Conclusion: Most SCD patients showed impairments on cognitive tests, but there was no statistically significant correlation between the presence of neurovascular damage and worse performance on the tests.

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