scholarly journals Transcranial Doppler Study Among Children with Sickle Cell Anaemia Vs Normal Children

2012 ◽  
Vol 32 (2) ◽  
pp. 146-149 ◽  
Author(s):  
BB Lakhkar ◽  
BN Lakhkar ◽  
P Vaswani
Keyword(s):  
Sickle Cell Disease ◽  
Flow Velocity ◽  
Sickle Cell ◽  
Cerebral Artery ◽  
Transcranial Doppler ◽  
Cell Disease ◽  
Mean Flow ◽  
Mean Velocity ◽  
Mean Flow Velocity ◽  
Age And Sex

Introduction: Role of transcranial Doppler in prevention of stroke in sickle cell children has been well appreciated. Studies are being done to develop the protocol in children. Since we don’t find stroke very commonly in this part of the world, this study was done in order to see the prevalence of abnormal flow velocity in sickle children attending sickle cell clinic. The aims of this study were to measure mean flow velocity in different vessels in homozygous sickle cell patients using transcranial Doppler study, to compare the mean velocity in sickle children with age and sex matched controls and to correlate mean velocity with headache or stroke if any and also to correlate mean velocity with number of transfusions. Materials and Methods: The study was done in Paediatric wards. It was a prospective crosssectional comparative study. Twenty six children below 14yrs of age with homozygous sickle cell disease attending the Sickle cell clinic were selected as the cases. Forty cases of similar age and sex were recruited as normal control group. Transcranial Doppler was done in six different vessels in both the groups and mean flow velocity was measured. Mean flow velocity was correlated with symptoms and number of transfusions. Velocity was classified as normal (<170cm/sec), conditional (170-199cm/sec) or abnormal (>200cm/sec). Statistical analysis was done using SPSS 10 software. Results: In normal age and sex matched controls mean blood flow velocity was 50cm/sec where as in the cases of sickle cell disease was 180cm/sec. Maximum mean velocity was observed in middle and posterior cerebral artery. In two Sickle cell cases (8%) blood flow velocity was abnormal, these children had headache though received 5-10 transfusions/year. In only 4% sickle cell children flow velocity was normal and rest had conditional velocity. Among these children 39% received less than 5 and rest received 5-9 transfusions /yr and had no symptoms of stroke. Conclusions: Flow velocity measured by Transcranial Doppler is highest in middle cerebral artery and Posterior cerebral artery which appear to be the best arteries for this test in this region. Flow velocity was significantly high in children with sickle cell disease as compared to normal children. Prevalence of abnormal flow velocity in our children was 8% and children with abnormal mean flow velocity presented with headache. J. Nepal Paediatr. Soc. 32(2) 2012 146-149 doi: http://dx.doi.org/10.3126/jnps.v32i2.5681

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.

scholarly journals Patients with sickle cell disease are frequently excluded from the benefits of transcranial doppler screening for the risk of stroke despite extensive and compelling evidence

2017 ◽  
Vol 75 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Daniela Laranja Gomes Rodrigues ◽  
Samuel Ademola Adegoke ◽  
Rejane de Souza Macedo Campos ◽  
Josefina Aparecida Pellegrini Braga ◽  
Maria Stella Figueiredo ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Transcranial Doppler ◽  
Stroke Prevention ◽  
Cell Disease ◽  
Mean Flow ◽  
Medical Centers ◽  
Left And Right ◽  
First Time ◽  
Missed Opportunity

ABSTRACT Transcranial doppler (TCD) is a strategic component of primary stroke prevention in children with sickle cell disease (SCD). This study was conducted to examine the TCD characteristics of children with SCD in nine different medical centers in Brazil. Methods: Transcranial doppler was performed in accordance with the Stroke Prevention Trial in Sickle Cell Anemia Protocol. Results: Of the 396 patients, 69.5% had homozygous SS hemoglobin. The TCD result was abnormal in 4.8%, conditional in 12.6%, inadequate in 4.3% and abnormally low in 1% of patients. The highest mean flow velocities were 121±23.83cm/s and 124±27.21cm/s in the left and right middle cerebral artery respectively. A total of 28.8% patients (mean age 9.19±5.92 years) were evaluated with TCD for the first time. Conclusions: The SCD patients were evaluated with TCD at an older age, representing an important missed opportunity for stroke prevention. Since TCD screening in patients with SCD is important to detect those at high risk for stroke, it is recommended that this screening should be made more readily available.

scholarly journals Results from transcranial Doppler examination on children and adolescents with sickle cell disease and correlation between the time-averaged maximum mean velocity and hematological characteristics: a cross-sectional analytical study

2011 ◽  
Vol 129 (3) ◽  
pp. 134-138 ◽  
Author(s):  
Mary Hokazono ◽  
Gisele Sampaio Silva ◽  
Edina Mariko Koga Silva ◽  
Josefina Aparecida Pellegrini Braga
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Transcranial Doppler ◽  
Analytical Study ◽  
Hematological Parameters ◽  
Cell Disease ◽  
Mean Velocity ◽  
Cross Sectional ◽  
Group I

CONTEXT AND OBJECTIVE: Transcranial Doppler (TCD) detects stroke risk among children with sickle cell anemia (SCA). Our aim was to evaluate TCD findings in patients with different sickle cell disease (SCD) genotypes and correlate the time-averaged maximum mean (TAMM) velocity with hematological characteristics. DESIGN AND SETTING: Cross-sectional analytical study in the Pediatric Hematology sector, Universidade Federal de São Paulo. METHODS: 85 SCD patients of both sexes, aged 2-18 years, were evaluated, divided into: group I (62 patients with SCA/Sß0 thalassemia); and group II (23 patients with SC hemoglobinopathy/Sß+ thalassemia). TCD was performed and reviewed by a single investigator using Doppler ultrasonography with a 2 MHz transducer, in accordance with the Stroke Prevention Trial in Sickle Cell Anemia (STOP) protocol. The hematological parameters evaluated were: hematocrit, hemoglobin, reticulocytes, leukocytes, platelets and fetal hemoglobin. Univariate analysis was performed and Pearson's coefficient was calculated for hematological parameters and TAMM velocities (P < 0.05). RESULTS: TAMM velocities were 137 ± 28 and 103 ± 19 cm/s in groups I and II, respectively, and correlated negatively with hematocrit and hemoglobin in group I. There was one abnormal result (1.6%) and five conditional results (8.1%) in group I. All results were normal in group II. Middle cerebral arteries were the only vessels affected. CONCLUSION: There was a low prevalence of abnormal Doppler results in patients with sickle-cell disease. Time-average maximum mean velocity was significantly different between the genotypes and correlated with hematological characteristics.

Abstract P582: Accuracy of Transcranial Doppler in Detection of Intracranial Stenosis in Patients With Sickle Cell Disease

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nastajjia Krementz ◽  
Hannah Gardener ◽  
Luis F Torres ◽  
Moayd Alkhalifah ◽  
Iszet Campo-Bustillo ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Transcranial Doppler ◽  
Predictive Value ◽  
Hemoglobin Level ◽  
Intracranial Stenosis ◽  
Cell Disease ◽  
Mean Flow ◽  
Vessel Stenosis ◽  
Flow Velocities

Background: Stroke is among the most devastating consequences of sickle cell disease (SCD). Most SCD strokes occur due to intracranial stenosis, that can be detected by increased flow velocities on Transcranial Doppler (TCD). However, increased velocities may also reflect anemia rather than arteriopathy and vessel stenosis. We aimed to assess the accuracy of TCD in detection of intracranial stenosis in SCD. Methods: Pediatric SCD patients with at least one TCD and MRA within one month apart were identified from a retrospectively collected database maintained at our institution from January 2000 to December 2016. Patient demographics, hemoglobin level, transfusion and hydroxyurea status were collected, along with mean flow velocities (mFV) and degree of stenosis from bilateral middle and anterior cerebral, and internal carotid arteries. A mFV of > 200 cm/s and vessel stenosis > 50% were considered abnormal. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were obtained to assess overall accuracy of TCD velocities in relation to vessel stenosis. Multivariate analysis was performed to identify independent factors associated with MRA stenosis. Results: A total of 164 patients were included in the database (median age 12 [IQR 8.9] years, 56% had ischemic strokes) and 64 of them had at least one TCD and MRA one month apart. Of these, 20% had ischemic strokes, 17% had MRA stenosis > 50% and 10% had TCD velocity > 200 cm/s. TCD mFV > 200 cm/s had a high specificity (95%) and NPV (87%) but low sensitivity (29%) and PPV (55%) when compared to MRA stenosis > 50%. As a continuous variable, TCD mFV 137.5 cm/s had the best balance between maximal specificity (77%) and sensitivity (72%). After adjustment for age, hemoglobin level, transfusion status, hydroxyurea, and vessel, for every increase in cm/sec on TCD, there was a 2% increase in the odds of > 50% stenosis on MRA (OR=1.02, 95% CI 1.01-1.03, p<0.001). Conclusion: Our study reports that TCD mFV is a positive predictor of MRA stenosis in SCD, independent of patient characteristics, including hemoglobin. A mFV > 200 cm/s is highly specific but less sensitive to detect stenosis > 50%. Lower mFV cut points may need to be considered for early detection of intracranial stenosis and risk of stroke.

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