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Sickle cell disease: Ischemia and seizures
Author(s) -
Prengler Mara,
Pavlakis Steven G.,
Boyd Stewart,
Connelly Alan,
Calamante Fernando,
Chong W. K.,
Saunders Dawn,
Cox Timothy,
Bynevelt Michael,
Lane Roderick,
Laverty Aidan,
Kirkham Fenella J.
Publication year - 2005
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.20556
Subject(s) - medicine , asymptomatic , transcranial doppler , magnetic resonance imaging , stroke (engine) , population , cardiology , epilepsy , central nervous system disease , ischemia , perfusion , anesthesia , radiology , psychiatry , mechanical engineering , environmental health , engineering
Although the prevalence of seizures in children with sickle cell disease (SCD) is 10 times that of the general population, there are few prospectively collected data on mechanism. With transcranial Doppler and magnetic resonance imaging (MRI) and angiography, we evaluated 76 patients with sickle cell disease, 29 asymptomatic and 47 with neurological complications (seizures, stroke, transient ischemic attack, learning difficulty, headaches, or abnormal transcranial Doppler), who also underwent bolus‐tracking perfusion MRI. The six patients with recent seizures also had electroencephalography. Group comparisons (seizure, nonseizure, and asymptomatic) indicated that abnormal transcranial Doppler was more common in the seizure (4/6; 67%) and nonseizure (26/41; 63%) groups than in the asymptomatic (10/29; 34%) group (χ 2 ; p = 0.045), but abnormal structural MRI (χ 2 ; p = 0.7) or magnetic resonance angiography (χ 2 ; p = 0.2) were not. Relative decreased cerebral perfusion was found in all seizure patients and in 16 of 32 of the remaining patients with successful perfusion MRI ( p = 0.03). In the seizure patients, the perfusion abnormalities in five were ipsilateral to electroencephalographic abnormalities; one had normal electroencephalogram results. These findings suggest that vasculopathy and focal hypoperfusion may be factors in the development of sickle cell disease–associated seizures. Ann Neurol 2005;58:290–302