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Year : 2012  |  Volume : 3  |  Issue : 1  |  Page : 28-35

Neurocognitive functioning as a predictor of silent infarction in children with sickle cell disease

1 Professor of Pediatrics, Faculty of Medicine, Zagazig University, and Consultant Pediatrician at King Abdulaziz University Hospital at Jeddah, Saudi Arabia
2 Lecturer of Pediatrics, Faculty of Medicine, Menoufia University, Saudi Arabia
3 Assistant Prof. of Psychiatry, Faculty of Medicine, Zagazig University, Saudi Arabia
4 Assistant Professor of Radiology at HAU in Jeddah, Saudi Arabia

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Source of Support: None, Conflict of Interest: None

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Background and aim : Cerebral vascular accident (CVA) or stroke is one of the major complications of hemoglobin SS (HgbSS) disease, which has a negative impact on physical and neurocognitive function in children. Overt cerebral infarction usually affects physical and cognitive function, but silent infarction affects neurocognitive function rather than physical function. We aimed to determine whether neurocognitive function was a predictor of silent infarction. Patients and method: A total of 60 children with sickle cell disease (SCD; HgbSS), aged 6-12 years were included in this study. They were subjected to history taking, clinical examination, medical file review, severity score, brain magnetic resonance imaging, and neuropsychological evaluation. The children with a documented history of CVA and those with both clinical and MRI indications of an infarct were classified as having an overt infarct. The children with MRI scans suggestive of infarction without the presence of corresponding clinical findings were classified as having silent infarct. Children with no pathology in medical records or MRI were classified as normal. Results: Central nervous system (CNS) abnormalities were identified on MRI in 33.3% of the children. The highest frequency of damage was in the frontal lobe. In fact, 90% (n = 18) of the CVA and silent group had sustained some type of frontal lobe injury. The overt CVA groups evidenced a greater frequency of symptoms and lower hemoglobin than the silent infarct group or the group without CNS pathology. The children with documented clinical strokes performed more poorly than the studied peers on tasks requiring sustained attention and effort or tasks that were associated with frontal lobe involvement. In the area of attention, children who showed silent strokes on the MRI also showed similar impairments as their peers who had sustained overt strokes. Conclusion: Silent stroke is not an uncommon phenomenon in children with SCD and may lead to neurocognitive impairment; moreover, neuropsychological evaluation is a good predictor. Recommendations: Neuropsychological evaluation should be performed for severe sicklers and those with attention deficit, and the abnormal results should be confirmed by MRI.

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