Neurocognitive Functioning as a Predictor for Silent Infarction in Children with Sickle Cell Disease
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- Category: Vol. 80, March 2012
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Neurocognitive Functioning as a Predictor for Silent Infarction in Children with Sickle Cell Disease,MOHAMED A. ELSAYED, HATEM ELSHORBAGY, MOHAMED G. SEHLO and SAWSAN ASHOUR
Abstract
Introduction and Aim of the Work: Cerebral vascular accident (CVA) or stroke is one of the major complications of hemoglobin SS (Hgb SS) disease which has –ve impact for physical as well as neurocognitive function in children. Overt cerebral infarction usually affect physical and cognitive function but silent infarction affects neurocognitive function rather than physical impairment. We aimed to answer the question could neurocognitive function be a predictor for diagnosis of silent infarction?
Patients and Method: This study was carried on 60 child with SCD (HbSS), their ages ranged from (6-12) years. They were subjected to history taking, clinical examination, review of medical file, severity score, brain MRI and neuropsycho-logical evaluation. Children with a documented history of a CVA and those who have both clinical and MRI evidence indicating an infarct were classified as having an overt infarct. children with MRI scans suggestive of infarction without corresponding clinical findings were classified as having silent infarct. If there was no pathology shown in the medical record or the MRI, the child was 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 group with overt CVAs evidenced a greater frequency of symptoms ever and lower hemoglobin than did either the group classified without CNS pathology or the silent infarct group. Children with documented clinical strokes performed more poorly than the studied peers on tasks requiring sustained attention and effort or on 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 sustained overt strokes.
Conclusion: We concluded that silent stroke is not an uncommon phenomena in children with SCD which may lead to neurocognitive impairment and neuropsychological evalu-ation 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.