The use of transcranial ultrasonography to predict stroke in sickle cell disease

Robert Adams, Fenwick T Nichols, Elizabeth Carl, Dao Long Zhang, David C Hess, Virgil Mckie, Kathy Mckie, Ramon E Figueroa Ortiz, Mark Litaker, William Thompson

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Abstract

Background. Stroke, especially cerebral infarction, is a major cause of morbidity and mortality in children with sickle cell disease. Primary prevention of stroke by transfusion therapy may be feasible if there is a way to identify the patients at greatest risk. Transcranial Doppler ultrasonography can measure flow velocity in the large intracranial arteries. The narrowing of these arteries, which leads to cerebral infarction, is characterized by an increased velocity of flow. Methods. Using transcranial Doppler ultrasonography, we prospectively measured the velocity of cerebral blood flow in children and young adults being followed because of sickle cell disease. The results were classified as either normal or abnormal on the basis of the highest velocity of flow in the middle cerebral artery. Abnormal velocity was defined as a flow ≥170 cm per second, a definition determined by post hoc analysis to maximize the predictive success of the test. The end point was a clinically apparent first cerebral infarction. Results. Two hundred eighty-three transcranial ultrasound examinations were performed in 190 patients with sickle cell disease (age at entry, 3 to 18 years). After an average follow-up of 29 months, cerebral infarction was diagnosed in seven patients. In 23 patients the results of the ultrasound examinations were abnormal, and in 167 patients they were normal. The clinical and hematologic characteristics of the two groups were similar, but six of the seven strokes occurred among the 23 patients with abnormal ultrasound results (P<0.00001 by Fisher's exact test). In this group, the relative risk of stroke was 44 (95 percent confidence interval, 5.5 to 346). Conclusions. Transcranial ultrasonography can identify the children with sickle cell disease who are at highest risk for cerebral infarction. Periodic ultrasound examinations and the selective use of transfusion therapy could make the primary prevention of stroke an achievable goal. (N Engl J Med 1992;326:605–10.).

Original languageEnglish (US)
Pages (from-to)605-610
Number of pages6
JournalNew England Journal of Medicine
Volume326
Issue number9
DOIs
StatePublished - Feb 27 1992

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Sickle Cell Anemia
Cerebral Infarction
Ultrasonography
Stroke
Doppler Transcranial Ultrasonography
Primary Prevention
Cerebrovascular Circulation
Arteries
Child Mortality
Middle Cerebral Artery
Young Adult
Confidence Intervals
Morbidity
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

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The use of transcranial ultrasonography to predict stroke in sickle cell disease. / Adams, Robert; Nichols, Fenwick T; Carl, Elizabeth; Zhang, Dao Long; Hess, David C; Mckie, Virgil; Mckie, Kathy; Figueroa Ortiz, Ramon E; Litaker, Mark; Thompson, William.

In: New England Journal of Medicine, Vol. 326, No. 9, 27.02.1992, p. 605-610.

Research output: Contribution to journalArticle

Adams, Robert ; Nichols, Fenwick T ; Carl, Elizabeth ; Zhang, Dao Long ; Hess, David C ; Mckie, Virgil ; Mckie, Kathy ; Figueroa Ortiz, Ramon E ; Litaker, Mark ; Thompson, William. / The use of transcranial ultrasonography to predict stroke in sickle cell disease. In: New England Journal of Medicine. 1992 ; Vol. 326, No. 9. pp. 605-610.
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abstract = "Background. Stroke, especially cerebral infarction, is a major cause of morbidity and mortality in children with sickle cell disease. Primary prevention of stroke by transfusion therapy may be feasible if there is a way to identify the patients at greatest risk. Transcranial Doppler ultrasonography can measure flow velocity in the large intracranial arteries. The narrowing of these arteries, which leads to cerebral infarction, is characterized by an increased velocity of flow. Methods. Using transcranial Doppler ultrasonography, we prospectively measured the velocity of cerebral blood flow in children and young adults being followed because of sickle cell disease. The results were classified as either normal or abnormal on the basis of the highest velocity of flow in the middle cerebral artery. Abnormal velocity was defined as a flow ≥170 cm per second, a definition determined by post hoc analysis to maximize the predictive success of the test. The end point was a clinically apparent first cerebral infarction. Results. Two hundred eighty-three transcranial ultrasound examinations were performed in 190 patients with sickle cell disease (age at entry, 3 to 18 years). After an average follow-up of 29 months, cerebral infarction was diagnosed in seven patients. In 23 patients the results of the ultrasound examinations were abnormal, and in 167 patients they were normal. The clinical and hematologic characteristics of the two groups were similar, but six of the seven strokes occurred among the 23 patients with abnormal ultrasound results (P<0.00001 by Fisher's exact test). In this group, the relative risk of stroke was 44 (95 percent confidence interval, 5.5 to 346). Conclusions. Transcranial ultrasonography can identify the children with sickle cell disease who are at highest risk for cerebral infarction. Periodic ultrasound examinations and the selective use of transfusion therapy could make the primary prevention of stroke an achievable goal. (N Engl J Med 1992;326:605–10.).",
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AU - Zhang, Dao Long

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AU - Mckie, Virgil

AU - Mckie, Kathy

AU - Figueroa Ortiz, Ramon E

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AB - Background. Stroke, especially cerebral infarction, is a major cause of morbidity and mortality in children with sickle cell disease. Primary prevention of stroke by transfusion therapy may be feasible if there is a way to identify the patients at greatest risk. Transcranial Doppler ultrasonography can measure flow velocity in the large intracranial arteries. The narrowing of these arteries, which leads to cerebral infarction, is characterized by an increased velocity of flow. Methods. Using transcranial Doppler ultrasonography, we prospectively measured the velocity of cerebral blood flow in children and young adults being followed because of sickle cell disease. The results were classified as either normal or abnormal on the basis of the highest velocity of flow in the middle cerebral artery. Abnormal velocity was defined as a flow ≥170 cm per second, a definition determined by post hoc analysis to maximize the predictive success of the test. The end point was a clinically apparent first cerebral infarction. Results. Two hundred eighty-three transcranial ultrasound examinations were performed in 190 patients with sickle cell disease (age at entry, 3 to 18 years). After an average follow-up of 29 months, cerebral infarction was diagnosed in seven patients. In 23 patients the results of the ultrasound examinations were abnormal, and in 167 patients they were normal. The clinical and hematologic characteristics of the two groups were similar, but six of the seven strokes occurred among the 23 patients with abnormal ultrasound results (P<0.00001 by Fisher's exact test). In this group, the relative risk of stroke was 44 (95 percent confidence interval, 5.5 to 346). Conclusions. Transcranial ultrasonography can identify the children with sickle cell disease who are at highest risk for cerebral infarction. Periodic ultrasound examinations and the selective use of transfusion therapy could make the primary prevention of stroke an achievable goal. (N Engl J Med 1992;326:605–10.).

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