Silent Brain Changes in Children with Sickle Cell Disease

Abstract

Background: Cerebrovascular steno-occlusive disease constitutes one of the most dangerous complications of sickle cell disease (SCD). It could result in overt or silent cerebral infarctions (SCI). Objective: The aim of this study was to demonstrate silent parenchymal and vascular brain changes that are incidentally observed in neurologically free SCD children using screening MRI and MRA. Patients and methods: This prospective cross-sectional study was conducted on 78 children diagnosed with SCD who were neurologically free. Magnetic resonance imaging (MRI) and Magnetic Resonance Angiography (MRA) were done to all the participant children. Results: Thirty (38.4%) of our children demonstrated pathologic parenchymal features on their MRI. There were 29 (37.17%) patients had pathologic changes in MRA; 6 of them had isolated vascular abnormality, whereas the remaining patients had concurrent parenchymal abnormalities. There was significant high positive correlation between low hemoglobin and presence of silent cerebral infarction (SCI). Moya-moya vasculopathy showed significant positive correlation with arterial occlusion and old SCI. HB SS phenotype was significantly correlated with moya-moya vasculopathy, arterial occlusion and old SCI. Conclusions: Silent cerebral and cerebrovascular changes in SCD children are frequent abnormalities requiring utilization of MRI and MRA to find out their exact prevalence and their risk factors.