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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(01): 15-19
DOI: 10.1590/0004-282X20160175
Article

Patients with sickle cell disease are frequently excluded from the benefits of transcranial doppler screening for the risk of stroke despite extensive and compelling evidence

Pacientes com doença falciforme são frequentemente excluídos dos benefícios do screening com doppler transcraniano para avaliação do risco de acidente vascular cerebral, apesar de evidência extensa e convincente
Daniela Laranja Gomes Rodrigues
1   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
,
Samuel Ademola Adegoke
2   Department of Pediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
3   Universidade Federal de São Paulo, Departamento de Oncologia Clínica e Experimental, São Paulo SP, Brasil
,
Rejane de Souza Macedo Campos
1   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
,
Josefina Aparecida Pellegrini Braga
4   Universidade Federal de São Paulo, Departamento de Pediatria, São Paulo SP, Brasil
,
Maria Stella Figueiredo
3   Universidade Federal de São Paulo, Departamento de Oncologia Clínica e Experimental, São Paulo SP, Brasil
,
Gisele Sampaio Silva
1   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
5   Hospital Israelita Albert Einstein, Programa Integrado de Neurologia, São Paulo SP, Brasil
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ABSTRACT

Transcranial doppler (TCD) is a strategic component of primary stroke prevention in children with sickle cell disease (SCD). This study was conducted to examine the TCD characteristics of children with SCD in nine different medical centers in Brazil.

Methods:

Transcranial doppler was performed in accordance with the Stroke Prevention Trial in Sickle Cell Anemia Protocol.

Results:

Of the 396 patients, 69.5% had homozygous SS hemoglobin. The TCD result was abnormal in 4.8%, conditional in 12.6%, inadequate in 4.3% and abnormally low in 1% of patients. The highest mean flow velocities were 121±23.83cm/s and 124±27.21cm/s in the left and right middle cerebral artery respectively. A total of 28.8% patients (mean age 9.19±5.92 years) were evaluated with TCD for the first time.

Conclusions:

The SCD patients were evaluated with TCD at an older age, representing an important missed opportunity for stroke prevention. Since TCD screening in patients with SCD is important to detect those at high risk for stroke, it is recommended that this screening should be made more readily available.

RESUMO

Doppler transcraniano (DTC) é um componente estratégico da prevenção primária do acidente vascular cerebral (AVC) em crianças com doença falciforme (DF). Este estudo foi realizado para examinar as características do DTC de crianças com DF em nove centros médicos diferentes no Brasil.

Métodos:

DTC foi realizado de acordo com o protocolo de Stroke Prevention Trial in Sickle Cell Anemia Protocol (STOP).

Resultados:

Dos 396 pacientes avaliados, 69,5% eram homozigotos para hemoglobina SS. DTC foi anormal em 4,8%, condicional em 12,6%, inadequado em 5,3% e anormalmente baixo em 1%. As máximas velocidades de fluxo médio foram 121 ± 23,83cm/s e 124 ± 27,21 cm/s nas artérias cerebrais media esquerda e direita, respectivamente. Um total de 28,8% dos pacientes (média de 9,19 ± 5,92 anos) foram avaliados com o DTC pela primeira vez.

Conclusões:

Pacientes com DF foram avaliados com DTC numa idade considerada avançada, o que representa uma importante oportunidade perdida para a prevenção de AVC nessa população. Uma vez que a triagem com DTC em pacientes com DF é essencial para detectar aqueles com alto risco de AVC, recomenda-se que essa triagem seja amplamente disponível no país.

Keywords:

sickle cell disease - ultrasonography - doppler - transcranial - stroke

Palavras-chave:

anemia falciforme - ultrassonografia - doppler transcraniano - acidente vascular cerebral


Publication History

Received: 18 March 2016

Accepted: 01 September 2016

Article published online:
06 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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