Stroke and Sickle Cell Disease in Children

Introduction: Stroke is a serious vaso-occlusive complication in children with major sickle cell syndromes. In Senegal, this topic has been little studied. Few studies have been reported about stroke in children with sickle cell disease. In order to contribute to a better knowledge of this topic, we performed this study. Our aim was to describe the epidemiological, clinical, paraclinical and evolutionary aspects of stroke, in children followed in a specialized children sickle cell unit. Patients and Methods: We conducted a retrospective, descriptive, and analytical study of patients treated at the Outpatient Care Unit for Children and Adolescents with Sickle Cell Disease (USAD) of the Albert Royer National Children’s Hospital (CHNEAR) from May 2018 to April 2019. We included all sickle cell patients with at least one stroke. Results: The hospital prevalence was 2.5% and the sex ratio was 0.88. The 5 - 14 age group was the most represented. Homozygous SS sickle cell patients were the most affected (96%). Motor deficit was the main circumstance of stroke discovery (91.7%). The mean baseline Hb level was 7.7 ± 1.1 g/dl, the white blood cell level was 14538.6 ± 3816.5/mm3, and the platelet level was 476107.1 ± 127508.8/mm3. A brain CT scan was performed in 48 patients (75%) and a brain MRI in 5 patients (10.4%). Middle cerebral artery involvement was the most common (64.6%). A blood transfusion was performed in 56.3% of patients after the stroke. The outcome showed complete recovery of motor deficit in 10 patients (20.8%). However, recurrence occurred in 13/48 (27.1%). The main factors associated with stroke were tonsillar hypertrophy (37.5%) and adenoid hypertrophy (8.3%). Conclusion: Stroke was relatively common in our study. The middle cerebral artery was the most commonly affected. High obstructions were the main risk factors.