Silent cerebral infarct in sickle cell anemia patients of southern Turkey

Silent cerebral infarct in sickle cell anemia patients of southern Turkey

Background/aim: Silent cerebral infarct (SCI) is an ischemic lesion seen before clinical signs of brain infarct and ischemic changes in brain tissue. This study aimed to detect SCI with noninvasive methods and to determine related risk factors in patients with sickle cell anemia (SCA). Materials and methods: Fifty-four SCA patients who had no history of cerebral infarct and whose neurological examinations were normal were included in this study. Brain magnetic resonance imaging (MRI) and diffusion MRI were taken and the acquired data was compared statistically. Results: SCI was detected in 11.1% (6/54) of the patients. No statistical differences in age, sex, physical examination findings, or treatments were detected between the 2 groups (with and without SCI). When examined in terms of HbS, the median (min–max) value in SCI-positive patients was 85.4 (80.5–92.1); the median value was 77.2 (49.0–96.7) in SCI-negative patients. The HbS values of the SCI group were statistically significantly higher than those of the group without SCI (P = 0.014). Patients with the HbSS or HbSβ0 genotypes had a significantly higher prevalence of SCI when compared with other sickle cell syndromes (P = 0.038). Conclusion: SCI is not uncommon among SCA patients in Turkey. The presence of homozygote HbSS/Sβ0 genotype, high MCV, and HbS are risk factors for SCI.

___

  • 1. Weatherall DJ, Clegg JB. Inherited haemoglobin disorders: an increasing global health problem. Bulletin of the World Health Organization 2001;79 (8):704-712. World Health Organization. https://apps.who.int/iris/handle/10665/268402
  • 2. Harmening DM. The Hemoglobinopathies. Clinical Hematology and Fundamentals of Hemostasis. Philadelphia, PA, USA: F.A. Davis Company; 2008. pp. 173-192.
  • 3. Arcasoy A, Canatan D. Dünyada ve Türkiye’de talasemi ve hemoglobinopatiler. In: Ulusal Hemoglobinopati KonseyiSağlık Bakanlığı 2003; Antalya, Türkiye. pp. 66: 11-19.
  • 4. Lanzkowski P. Manual of Pediatric Hematology and Oncology. Fifth Edition. Cambridge, Massachusetts, USA: Elsevier 2011;(8) 200-228
  • 5. Hebbel RP. Pathobiology of sickle cell disease. Hematology Basic Principles and Practice (Hoffman R, Benz EJ, Shattil SJ). 5th ed. Philadelphia, PA, USA: Elsevier Churchill Livingstone 2009; 565-576
  • 6. Vermeer SE, Longstreth Jr WT, Koudstaal PJ. Silent brain infarcts: systematic review. The Lancet Neurology 2007; 6: 611- 619.doi: 10.1016/S1474-4422(07)70170-9
  • 7. Bernick C, Kuller L, DulbergC, Longstreth Jr WT, Manolio T et al. Silent MRI infarcts and the risk of future stroke: the cardiovascular health study. Neurology 2001:57;1222-1229. doi: 10.1212/wnl.57.7.1222
  • 8. Lim JS, Kwon HM. Risk of “silent stroke” in patients older than 60 years: risk assessment and clinical perspectives. Clinical Interventions in Aging 2010;7: 5:239-251. doi: 10.2147/cia. s7382
  • 9. Ciurea SO, Thulborn KR, Gowhari M. Dural venous sinus thrombosis in a patient with sickle cell disease: case report and literature review. American Journal of Hematology 2006; 81: 290-293.doi: 10.1002/ajh.20573
  • 10. Henderson JN, Noetzel MJ, McKinstry RC, White DA, Armstrong M et al. Reversible posterior leukoencephalopathy syndrome and silent cerebral infarcts are associated with severe acute chest syndrome in children with sickle cell disease. Blood 2003;15: 101: 415-419.doi: 10.1182/blood-2002-04-1183
  • 11. Wang WC. The pathophysiology, prevention, and treatment of stroke in sickle cell disease. Current Opinion in Hematology 2007;14(3): 191-197.doi: 10.1097/MOH.0b013e3280ec5243
  • 12. Adams RJ, McKie VC, Hsu L, Files B, Vichinsky E et al. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. New England Journal of Medicine1998;339(1): 5-11.doi: 10.1056/NEJM199807023390102
  • 13. Adams RJ, Ohene-Frempong K, Wang W. Sickle cell and the brain. Hematology, American Society of Hematology Education Program 2001; 31-46. doi: 10.1182/asheducation-2001.1.31
  • 14. Pegelow CH, Macklin EA, Moser FG, Wang WC, Bello JA et al. Longitudinal changes in brain magnetic resonance imaging findings in children with sickle cell disease. Blood 2002; 99 (8): 3014-3018.doi: 10.1182/blood.v99.8.3014
  • 15. Bernaudin F, Verlhac S, Arnaud C, Kamdem A, Chevret S et al. Impact of early transcranial Doppler screening and intensive therapy on cerebral vasculopathy outcome in a newborn sickle cell anemia cohort. Blood 2010; 117 (4): 1130-1140. doi: 10.1182/blood-2010-06-293514
  • 16. Kwiatkowski JL, Zimmerman RA, Pollock AN, Seto W, SmithWhitley K et al. Silent infarcts in young children with sickle cell disease. British Journal of Haematology 2009;146(3): 300-305. doi: 10.1111/j.1365-2141.2009.07753.x
  • 17. Charles TQ, Breakthrough: new guidance for silent cerebral ischemia and infarction in sickle cell disease. American Society of Hematology 2014; 438-443.doi: 10.1182/ asheducation-2014.1.438
  • 18. Vichinsky EP, Neumayr LD, Gold JI, Weiner MW, Rule RR et al. Neuropsychological dysfunction and neuroimaging abnormalities in neurologically intact adults with sickle cell anemia. JAMA. 2010; 303 (18): 1823-1831.doi: 10.1001/ jama.2010.562
  • 19. DeBaun MR, Sarnaik SA, Rodeghier MJ, Minniti CP, Howard TH et al. Associated risk factors for silent cerebral infarcts in sickle cell anemia: low baseline hemoglobin, sex, and relative high systolic blood pressure. Blood 2012;119(16): 3684-3689. doi: 10.1182/blood-2011-05-349621
  • 20. Kinney TR, Sleeper LA, Wang WC, Zimmerman RA, Pegelow CH et al. Silent cerebral infarcts in sickle cell anemia: a risk factor analysis. Pediatrics 1999;103(3): 640-645.doi: 10.1542/ peds.103.3.640
  • 21. Kawadler JM, Clayden JD, Clark CA, Kirkham FJ. Intelligence quotient in paediatric sickle cell disease: a systematic review and meta-analysis. Developmental Medicine & Child Neurology 2016; 1-8.doi: 10.1111/dmcn.13113
  • 22. Galadanci NA, Abdullahi SU, Tabari MA, Abubakar S, Belonwu R et al. Primary stroke prevention in Nigerian children with sickle cell disease (SPIN): challenges of conducting a feasibility trial. Pediatric Blood & Cancer 2015;62: 395-401.doi: 10.1002/ pbc.25289
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK
Sayıdaki Diğer Makaleler

A new predictor of bleeding based on ultrasonographic features in percutaneous liver mass biopsy

Mustafa ÖZDEMİR, Onur TAYDAŞ, Ömer Faruk ATEŞ, Ahmet Burak KARA, Mehmet GÖKTEPELİ

Research on the protective effect of caffeic acid phenethyl ester on testicular damage caused by cisplatin

Fazile CANTÜRK, Emin KAYMAK, Tayfun CEYLAN, Birkan YAKAN

Comment on: “Treatment of idiopathic granulomatous mastitis and factors related with disease recurrence”

Tevfik Tolga ŞAHİN, Sami AKBULUT

In reply: Comparing performance of McGrath MAC videolaryngoscope in morbidly obese and nonobese

Zehra İpek ARSLAN

Silent cerebral infarct in sickle cell anemia patients of southern Turkey

Göksel LEBLEBİSATAN, Yurdanur KILINÇ, Şerife LEBLEBİSATAN, Kenan BIÇAKÇI, Ezgi NAFİLE SAYMAN, Adnan BARUTÇU

Comment on ‘Treatment of idiopathic granulomatous mastitis and factors related with disease recurrence

Muhammet ÇINAR, Emre TEKGÖZ, Sedat YILMAZ, Seda ÇOLAK

COVID-19 experience of the major pandemic response center in the capital: results of the pandemic’s first month in Turkey

Fatma ESER, Müge AYHAN, Elif Mükime SARICAOĞLU, Rahmet GÜNER, Esragül AKINCI, Bedia DİNÇ, Adalet AYPAK, Yeşim AYBAR BİLİR, Nevzat Mehmet MUTLU, Işıl ÖZKOÇAK TURAN, Deniz ERDEM, Turan BUZGAN, Ayşe KAYA KALEM, Bircan KAYAASLAN, İmran HASANOĞLU, Burcu ÖZDEMİR

Anakinra, an interleukin-1 receptor antagonist, increases the morphine analgesic effect and decreases morphine tolerance development by modulating oxidative stress and endoplasmic reticulum stress in rats

Onur AVCI, Ahmet Şevki TAŞKIRAN

Effects of different epidural initiation volumes on postoperative analgesia in cesarean section

Osman KAÇMAZ, Nurçin GÜLHAŞ, Mahmut DURMUŞ, Gülay ERDOĞAN KAYHAN

Proteomic analysis of the anticancer effect of various extracts of endemic Thermopsis turcica in human cervical cancer cells

Nuray VAROL, Murat KASAP, Hakan TERZİ, Mustafa YILDIZ, Mustafa SOLAK, Müjgan ÖZDEMİR ERDOĞAN, Saliha Handan YILDIZ, Nermin AKÇALI