First Ischemic Stroke in Sickle-Cell Disease

Calvet, D.; Bernaudin, Françoise; Guéguen, Antoine; Hosseini, Hassan; Habibi, Anoosha; Galactéros, Frédéric; Bartolucci, Pablo

doi:10.1161/strokeaha.115.010153

Cited by 18 publications

(13 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is possible that shunting may have a pathological role in specific stroke subtypes. Our observations and recent studies in adults with SCA showing a high prevalence of cardioembolic etiologies for stroke (Calvet, et al, 2015) support paradoxical embolization via RLS as a possible cause of stroke in children with SCA.…”

Section: Discussionsupporting

confidence: 86%

“…In a recent study of 29 SCA patients with first ischaemic stroke in adulthood, 7/29 (24%) had cardiac embolism as an identified aetiology for their stroke (Calvet, et al, 2015). Large PFO was identified in 3 patients, dilated cardiomyopathy in 1 and fat embolism in another patient.…”

Section: Discussionmentioning

confidence: 99%

“…In the previously mentioned study of adults with SCA and stroke, 9/29 had recurrent stroke that was attributed to cardiac embolism in 4 cases. (Calvet, et al, 2015). In children with SCA, recurrent stroke is often attributed to moyamoya syndrome or progressive cerebral vasculopathy.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Increased prevalence of potential right‐to‐left shunting in children with sickle cell anaemia and stroke

et al. 2016

View full text Add to dashboard Cite

“Paradoxical” embolization via intracardiac or intrapulmonary right-to-left shunts (RLS) is an established cause of stroke. Hypercoagulable states and increased right heart pressure, which both occur in sickle cell anaemia (SCA), predispose to paradoxical embolization. We hypothesized that children with SCA and overt stroke (SCA+stroke) have an increased prevalence of potential RLS. We performed contrasted transthoracic echocardiograms on 147 children (aged 2–19 years) with SCA+stroke) mean age 12.7±4.8 years, 54.4% male) and a control group without SCA or stroke (n=123; mean age 12.1±4.9 years, 53.3% male). RLS was defined as any potential RLS detected by any method, including intrapulmonary shunting. Echocardiograms were masked and adjudicated centrally. The prevalence of potential RLS was significantly higher in the SCA+stroke group than controls (45.6% vs. 23.6%, p<0.001). The odds ratio for potential RLS in the SCA+stroke group was 2.7 (95% confidence interval: 1.6–4.6) vs controls. In post hoc analyses, the SCA+stroke group had a higher prevalence of intrapulmonary (23.8% vs. 5.7%, p<0.001) but not intracardiac shunting (21.8% vs. 18.7%, p=0.533). SCA patients with potential RLS were more likely to report headache at stroke onset than those without. Intrapulmonary and intracardiac shunting may be an overlooked, independent and potentially modifiable risk factor for stroke in SCA.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Increased prevalence of potential right‐to‐left shunting in children with sickle cell anaemia and stroke

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Thrombolytic therapy in acute ischaemic stroke in adults with SCD is then still debated and sometimes considered as an off-label use of these treatments 3. However, there are various causes of ischaemic stroke in adults with homozygous SCD 8. In our two cases, a Moyamoya syndrome associated with the specific SCD large-vessel vasculopathy had been ruled out before initiation of intravenous thrombolysis.…”

Section: Discussionmentioning

confidence: 92%

Thrombolytic therapy for the treatment of acute ischaemic stroke in adults with homozygous sickle cell disease

Majhadi¹,

Calvet²,

Rosso

et al. 2017

BMJ Case Reports

Self Cite

View full text Add to dashboard Cite

Stroke is a significant cause of morbidity and mortality in patients with homozygous sickle cell disease (SCD). A specific large-vessel vasculopathy is often responsible for both haemorrhagic and ischaemic strokes in patients with SCD. Although intravenous thrombolysis has been considered as a therapeutic option for acute ischaemic strokes in SCD, its use remains debated because of an increased risk of spontaneous intracranial haemorrhage reported in this disease. This risk of haemorrhage is mainly supported by the presence of a Moyamoya syndrome often associated with the specific vasculopathy in patients with homozygous SCD. We report two cases of patients with homozygous SCD treated with intravenous thrombolysis for an acute ischaemic stroke without haemorrhagic transformation. Our cases suggest that reperfusion strategy in acute ischaemic stroke in patients with homozygous SCD can be considered once associated Moyamoya syndrome has been ruled out. An international registry would be of interest as these situations are rare.

show abstract

“…One observational study found that first-ever ischemic stroke in adults with SCD was less often due to vasculopathy (41%) than in children with SCD and stroke (92%). 85 Cardioembolism accounted for 24% of first-ever ischemic strokes in adults, and 28% were cryptogenic. Adults also had a higher rate of stroke recurrence (16% at 2 years vs. none at 2 years for children) despite red cell transfusion therapy in those with vasculopathy.…”

Section: Sickle Cell Diseasementioning

confidence: 99%

Single Gene Causes of Stroke

Majersik

2017

Semin Neurol

View full text Add to dashboard Cite

Though rare, monogenic causes of stroke are recognizable by key clinical and radiographic features. A lack of epidemiological data leaves their true incidence unknown, but the most common monogenetic causes of stroke are sickle cell disease, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), Fabry's disease, and cerebral cavernous malformations. In this article, the author covers the epidemiology, clinical features, and treatment of those diseases as well as other well-described monogenic causes of ischemic and hemorrhagic stroke. A “shotgun” approach to genetic testing should be avoided in favor of targeted testing that can provide a higher yield. Neurologists caring for stroke patients should be familiar with these monogenic causes of stroke, as heightened awareness and an armamentarium of additional diagnostic techniques will allow neurologists to diagnose correctly, implement individual distinct treatment paradigms, and provide future risk assessment.

show abstract

First Ischemic Stroke in Sickle-Cell Disease

Cited by 18 publications

References 11 publications

Increased prevalence of potential right‐to‐left shunting in children with sickle cell anaemia and stroke

Increased prevalence of potential right‐to‐left shunting in children with sickle cell anaemia and stroke

Thrombolytic therapy for the treatment of acute ischaemic stroke in adults with homozygous sickle cell disease

Single Gene Causes of Stroke

Contact Info

Product

Resources

About