Silent brain infarcts in adult Kuwaiti sickle cell disease patients

• Published in: American journal of hematology Vol. 73; no. 4; pp. 240 - 243
• Main Authors: Marouf, R., Gupta, R., Haider, M.Z., Adekile, A.D.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.08.2003; Wiley-Liss
• Subjects: Adolescent; Adult; Age Factors; Anemia, Sickle Cell - complications; Anemias. Hemoglobinopathies; Biological and medical sciences; Cerebral Infarction - diagnosis; Cerebral Infarction - etiology; Diseases of red blood cells; Hematologic and hematopoietic diseases; Hematologic Tests; Hospitalization; Humans; Kuwait - epidemiology; Magnetic Resonance Imaging - methods; Medical sciences; Neurology; Thalassemia - complications; Vascular diseases and vascular malformations of the nervous system; Kuwait; Asia; Human; Hemoglobinopathy; Nervous system diseases; Stroke; Sickle cell anemia; Infarct; Cardiovascular disease; Exploration; Hemopathy; Asymptomatic; Nuclear magnetic resonance imaging; Cerebral disorder; Genetic disease; Vascular disease; Hemolytic anemia; Central nervous system disease; Medical imagery; Adult; Complication; Cerebrovascular disease; Age; Brain (vertebrata)
• ISSN: 0361-8609; 1096-8652
• DOI: 10.1002/ajh.10376

Although overt stroke is a common complication of sickle cell disease (SCD), its incidence is very low in Kuwaiti patients. On the other hand, the prevalence of silent brain infarcts, which is reported to be about 17–20% in American patients, has not been documented in adult Kuwaiti patients. This is a 1‐year study of consecutive, asymptomatic SCD patients seen in the hematology clinic of Mubarak Al‐Kabeer Hospital. Patients with a past history of seizure or any other neurological abnormality were excluded. The patients' charts were reviewed for frequency of hospitalizations, any documented complications, and steady‐state CBC. MRI was done with a 1.5‐Tesla unit with super‐conducting magnet. T1‐ and T2‐weighted sagittal and axial sections and proton‐density axial images were obtained in 5‐mm‐thick sections. Thirty‐five patients were studied, made up of 25 SS and 10 Sβ0Thal, aged between 17 and 44 years, with a mean age of 26.9 ± 9.3 years. MRI findings consistent with infarcts were found in 7 (20.0%) patients—6 SS and 1 Sβ0thal—with a mean age of 31.8 ± 8.2 years, which was significantly higher (P < 0.05) than the mean age of the unaffected group (25.1 – 9.0 years). There were also no differences in the mean Hb, Hb F, or any other hematological parameter in the two groups. Among the affected 6 SS, 2 had co‐existent α‐thal trait. It is interesting that, while silent infarcts are prevalent in young American patients, it is in the older age group that they occur in Kuwaiti patients. Further studies are needed to investigate the factors modulating this heterogeneity. Am. J. Hematol. 73:240–243, 2003. © 2003 Wiley‐Liss, Inc.