Delayed intracranial hemorrhage following cerebral infarction in sickle cell anemia.

D. Powars, R. J. Adams, Fenwick T Nichols, P. Milner, S. Charache, S. Sarnaik

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Abstract

Clinical and necropsy findings in 11 patients with sickle cell anemia (SS) indicate that intracranial hemorrhage (IH) is a delayed sequela of the same vasculopathy that causes cerebral infarction during childhood. Evidence of prior cerebral infarction during childhood included hemiparesis, seizures, an episode of coma, or mental retardation. Computerized tomography (CT) scans showed cerebral infarcts with lucent areas and dilated ventricles or cerebral atrophy. CT or magnetic resonance imaging (MRI) scans after the intracranial hemorrhage demonstrated intraventricular or intracerebral hemorrhages. Angiography or autopsy in seven patients showed widespread vascular occlusion and narrowing of arterial vessels. Moyamoya with internal carotid artery occlusion was identified in two cases. At the time of the IH, three patients were being treated with prophylactic transfusion regimens. We hypothesize that the central nervous system vasculopathy progresses over time and that arterial narrowing in both large and small vessels secondary to endothelial hyperplasia is followed by neovascularization and hemorrhage. Recognition of this pattern of delayed intracranial hemorrhage following cerebral infarction should encourage more intensive evaluation aimed at developing rational interventional therapy prior to a terminal intracranial hemorrhage.

Original languageEnglish (US)
Pages (from-to)79-82
Number of pages4
JournalJournal of the Association for Academic Minority Physicians : the official publication of the Association for Academic Minority Physicians
Volume1
Issue number3
Publication statusPublished - Jan 1 1990

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ASJC Scopus subject areas

  • Medicine(all)

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