CEREBRAL INFARCTS AND INTRACRANIAL HEMORRHAGE IN PATIENTS WITH SICKLE-CELL DISEASE

Two sickle cell patients with cerebral accidents, infarct and bleeding , are presented. Up to 15% of all sickle cell patients suffer cerebral events, 75% of which are infarcts, 25% intracranial hemorrhages. Infa rcts occur predominantly in children with a clustering around age 7, w hile bleeding predominates in adult life. Cerebral events are due to i ntimal changes, proliferation and finally occlusion of both small and large cerebral arteries. Infarcts present with hemiparesis, aphasia. l oss of vision and seizures whereas intracranial bleedings are associat ed with severe headache and/or loss of consciousness and coma. When ce rebral infarct is suspected, magnetic resonance imaging is the diagnos tic method of choice. Intracranial bleeding is best diagnosed by compu ted tomography or angiography. Partial exchange transfusion is indicat ed in both events to be followed by a chronic transfusion program of a s yet undetermined length. Routine magnetic resonance angiogram and/or transcranial doppler sonography in young asymptomatic sickle cell pat ients may make it possible in the future to detect patients at risk an d institute treatment prior to a cerebral accident.