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Silva M, Faustino P. From Stress to Sick(le) and Back Again-Oxidative/Antioxidant Mechanisms, Genetic Modulation, and Cerebrovascular Disease in Children with Sickle Cell Anemia. Antioxidants (Basel) 2023; 12:1977. [PMID: 38001830 PMCID: PMC10669666 DOI: 10.3390/antiox12111977] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Sickle cell anemia (SCA) is a genetic disease caused by the homozygosity of the HBB:c.20A>T mutation, which results in the production of hemoglobin S (HbS). In hypoxic conditions, HbS suffers autoxidation and polymerizes inside red blood cells, altering their morphology into a sickle shape, with increased rigidity and fragility. This triggers complex pathophysiological mechanisms, including inflammation, cell adhesion, oxidative stress, and vaso-occlusion, along with metabolic alterations and endocrine complications. SCA is phenotypically heterogeneous due to the modulation of both environmental and genetic factors. Pediatric cerebrovascular disease (CVD), namely ischemic stroke and silent cerebral infarctions, is one of the most impactful manifestations. In this review, we highlight the role of oxidative stress in the pathophysiology of pediatric CVD. Since oxidative stress is an interdependent mechanism in vasculopathy, occurring alongside (or as result of) endothelial dysfunction, cell adhesion, inflammation, chronic hemolysis, ischemia-reperfusion injury, and vaso-occlusion, a brief overview of the main mechanisms involved is included. Moreover, the genetic modulation of CVD in SCA is discussed. The knowledge of the intricate network of altered mechanisms in SCA, and how it is affected by different genetic factors, is fundamental for the identification of potential therapeutic targets, drug development, and patient-specific treatment alternatives.
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Affiliation(s)
- Marisa Silva
- Departamento de Genética Humana, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Av. Padre Cruz, 1649-016 Lisboa, Portugal;
| | - Paula Faustino
- Departamento de Genética Humana, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Av. Padre Cruz, 1649-016 Lisboa, Portugal;
- Grupo Ecogenética e Saúde Humana, Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
- Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
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2
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Hamdule S, Kirkham FJ. Brain Volumes and Cognition in Patients with Sickle Cell Anaemia: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1360. [PMID: 37628359 PMCID: PMC10453222 DOI: 10.3390/children10081360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023]
Abstract
Cognitive decline is a major problem in paediatric and adult patients with sickle cell anaemia (SCA) and affects the quality of life. Multiple studies investigating the association between quantitative and qualitative neuroimaging findings and cognition have had mixed results. Hence, the aetiology of cognitive decline in this population is not clearly understood. Several studies have established cerebral atrophy in SCA children as well as adults, but the relationship between cognition and brain volumes remains unclear. The purpose of this systematic review was therefore to evaluate the literature on regional brain volumes and their association with cognitive outcomes. We also meta-analysed studies which compared regional brain volumes between patients and controls. Studies report that patients with SCA tend to have lower grey matter volumes, including total subcortical volumes in childhood as compared to controls, which stabilise in young adulthood and may be subjected to decline with age in older adulthood. White matter volumes remain stable in children but are subjected to reduced volumes in young adulthood. Age and haemoglobin are better predictors of cognitive outcomes as compared to regional brain volumes.
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Affiliation(s)
- Shifa Hamdule
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK;
| | - Fenella J. Kirkham
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK;
- Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK
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3
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Abdi SS, De Haan M, Kirkham FJ. Neuroimaging and Cognitive Function in Sickle Cell Disease: A Systematic Review. CHILDREN 2023; 10:children10030532. [PMID: 36980090 PMCID: PMC10047189 DOI: 10.3390/children10030532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023]
Abstract
Sickle cell disease (SCD) is the most common inherited single-gene disease. Complications include chronic anaemia, reduced oxygen-carrying capability, and cerebral vasculopathy, resulting in silent cerebral infarction, stroke, and cognitive dysfunction with impairments in measures of executive function, attention, reasoning, language, memory, and IQ. This systematic review aims to investigate the association between neuroimaging findings and cognition in children with SCD. Searches of PubMed and Embase were conducted in March 2022. Studies were included if participants were <18 years, if original data were published in English between 1960 and 2022, if any genotype of SCD was included, and if the relationship between cognition and neuroimaging was examined. Exclusion criteria included case studies, editorials, and reviews. Quality was assessed using the Critical Appraisal Skills Programme Case Control Checklist. A total of 303 articles were retrieved; 33 met the eligibility criteria. The presence of overt or silent strokes, elevated blood flow velocities, abnormal functional connectivity, and decreased fMRI activation were associated with neuropsychological deficits in children with SCD when compared to controls. There is a critical need to address the disease manifestations of SCD early, as damage appears to begin at a young age. Most studies were cross-sectional, restricting the interpretation of the directionality of relationships. Future research employing longitudinal neuroimaging and neuropsychological assessments could improve our understanding of the cumulative consequences of SCD on the developing brain.
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Affiliation(s)
- Suad S. Abdi
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Michelle De Haan
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Fenella J. Kirkham
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK
- Child Health, University Hospital Southampton, Southampton SO16 6YD, UK
- Correspondence:
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Hamdule S, Kölbel M, Stotesbury H, Murdoch R, Clayden JD, Sahota S, Hood AM, Clark CA, Kirkham FJ. Effects of regional brain volumes on cognition in sickle cell anemia: A developmental perspective. Front Neurol 2023; 14:1101223. [PMID: 36860579 PMCID: PMC9968851 DOI: 10.3389/fneur.2023.1101223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023] Open
Abstract
Background and objectives Cognitive difficulties in people with sickle cell anemia (SCA) are related to lower processing speed index (PSI) and working memory index (WMI). However, risk factors are poorly understood so preventative strategies have not been explored. Brain volumes, specifically white matter volumes (WMV) which increases through early adulthood, have been associated with better cognition in healthy typically developing individuals. In patients with SCA, the reduced WMV and total subcortical volumes noted could explain cognitive deficits. We therefore examined developmental trajectories for regional brain volumes and cognitive endpoints in patients with SCA. Methods Data from two cohorts, the Sleep and Asthma Cohort and Prevention of Morbidity in SCA, were available. MRI data included T1-weighted axial images, pre-processed before regional volumes were extracted using Free-surfer. PSI and WMI from the Weschler scales of intelligence were used to test neurocognitive performance. Hemoglobin, oxygen saturation, hydroxyurea treatment and socioeconomic status from education deciles were available. Results One hundred and twenty nine patients (66 male) and 50 controls (21 male) aged 8-64 years were included. Brain volumes did not significantly differ between patients and controls. Compared with controls, PSI and WMI were significantly lower in patients with SCA, predicted by increasing age and male sex, with lower hemoglobin in the model for PSI but no effect of hydroxyurea treatment. In male patients with SCA only, WMV, age and socioeconomic status predicted PSI, while total subcortical volumes predicted WMI. Age positively and significantly predicted WMV in the whole group (patients + controls). There was a trend for age to negatively predict PSI in the whole group. For total subcortical volume and WMI, age predicted decrease only in the patient group. Developmental trajectory analysis revealed that PSI only was significantly delayed in patients at 8 years of age; the rate of development for the cognitive and brain volume data did not differ significantly from controls. Discussion Increasing age and male sex negatively impact cognition in SCA, with processing speed, also predicted by hemoglobin, delayed by mid childhood. Associations with brain volumes were seen in males with SCA. Brain endpoints, calibrated against large control datasets, should be considered for randomized treatment trials.
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Affiliation(s)
- Shifa Hamdule
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Melanie Kölbel
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom,Sleep Education and Research Laboratory, UCL Institute of Education, London, United Kingdom
| | - Hanne Stotesbury
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Russell Murdoch
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Jonathan D. Clayden
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sati Sahota
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Anna Marie Hood
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom,Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Christopher A. Clark
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fenella Jane Kirkham
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom,*Correspondence: Fenella Jane Kirkham ✉
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5
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Jacob M, Kawadler JM, Murdoch R, Ahmed M, Tutuba H, Masamu U, Shmueli K, Saunders DE, Clark CA, Kim J, Hamdule S, Makani J, Stotesbury H, Kirkham FJ. Brain volume in Tanzanian children with sickle cell anaemia: A neuroimaging study. Br J Haematol 2022; 201:114-124. [PMID: 36329651 DOI: 10.1111/bjh.18503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/10/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
Brain injury is a common complication of sickle cell anaemia (SCA). White matter (WM) and cortical and subcortical grey matter (GM), structures may have reduced volume in patients with SCA. This study focuses on whether silent cerebral infarction (SCI), vasculopathy or anaemia affects WM and regional GM volumes in children living in Africa. Children with SCA (n = 144; aged 5-20 years; 74 male) and sibling controls (n = 53; aged 5-17 years; 29 male) underwent magnetic resonance imaging. Effects of SCI (n = 37), vasculopathy (n = 15), and haemoglobin were assessed. Compared with controls, after adjusting for age, sex and intracranial volume, patients with SCA had smaller volumes for WM and cortical, subcortical and total GM, as well as bilateral cerebellar cortex, globus pallidus, amygdala and right thalamus. Left globus pallidus volume was further reduced in patients with vasculopathy. Putamen and hippocampus volumes were larger in patients with SCA without SCI or vasculopathy than in controls. Significant positive effects of haemoglobin on regional GM volumes were confined to the controls. Patients with SCA generally have reduced GM volumes compared with controls, although some subcortical regions may be spared. SCI and vasculopathy may affect the trajectory of change in subcortical GM and WM volume. Brain volume in non-SCA children may be vulnerable to contemporaneous anaemia.
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Affiliation(s)
- Mboka Jacob
- Department of Radiology and Imaging Muhimbili University of Health and Allied Sciences Dar Es Salaam Tanzania
| | - Jamie M. Kawadler
- Developmental Neurosciences Section UCL Great Ormond Street Institute of Child Health London UK
| | - Russell Murdoch
- Department of Medical Physics and Biomedical Engineering UCL London UK
| | - Magda Ahmed
- Department of Radiology Muhimbili Orthopaedic Institute Dar Es Salaam Tanzania
| | - Hilda Tutuba
- Muhimbili Sickle cell Program Muhimbili University of Health and Allied Sciences Dar Es Salaam Tanzania
| | - Upendo Masamu
- Muhimbili Sickle cell Program Muhimbili University of Health and Allied Sciences Dar Es Salaam Tanzania
| | - Karin Shmueli
- Department of Medical Physics and Biomedical Engineering UCL London UK
| | - Dawn E. Saunders
- Developmental Neurosciences Section UCL Great Ormond Street Institute of Child Health London UK
| | - Chris A. Clark
- Developmental Neurosciences Section UCL Great Ormond Street Institute of Child Health London UK
- Biomedical Research Centre Great Ormond Street hospital for Children London UK
| | - Jinna Kim
- Department of Radiology Yonsei University Seoul South Korea
| | - Shifa Hamdule
- Developmental Neurosciences Section UCL Great Ormond Street Institute of Child Health London UK
| | - Julie Makani
- Department of Haematology and Blood Transfusion Muhimbili University of Health and Allied Sciences Dar Es Salaam Tanzania
| | - Hanne Stotesbury
- Developmental Neurosciences Section UCL Great Ormond Street Institute of Child Health London UK
| | - Fenella J. Kirkham
- Developmental Neurosciences Section UCL Great Ormond Street Institute of Child Health London UK
- Biomedical Research Centre Great Ormond Street hospital for Children London UK
- Clinical Experimental Sciences University of Southampton Southampton UK
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González-Zacarías C, Choi S, Vu C, Xu B, Shen J, Joshi AA, Leahy RM, Wood JC. Chronic anemia: The effects on the connectivity of white matter. Front Neurol 2022; 13:894742. [PMID: 35959402 PMCID: PMC9362738 DOI: 10.3389/fneur.2022.894742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/29/2022] [Indexed: 01/26/2023] Open
Abstract
Chronic anemia is commonly observed in patients with hemoglobinopathies, mainly represented by disorders of altered hemoglobin (Hb) structure (sickle cell disease, SCD) and impaired Hb synthesis (e.g. thalassemia syndromes, non-SCD anemia). Both hemoglobinopathies have been associated with white matter (WM) alterations. Novel structural MRI research in our laboratory demonstrated that WM volume was diffusely lower in deep, watershed areas proportional to anemia severity. Furthermore, diffusion tensor imaging analysis has provided evidence that WM microstructure is disrupted proportionally to Hb level and oxygen saturation. SCD patients have been widely studied and demonstrate lower fractional anisotropy (FA) in the corticospinal tract and cerebellum across the internal capsule and corpus callosum. In the present study, we compared 19 SCD and 15 non-SCD anemia patients with a wide range of Hb values allowing the characterization of the effects of chronic anemia in isolation of sickle Hb. We performed a tensor analysis to quantify FA changes in WM connectivity in chronic anemic patients. We calculated the volumetric mean of FA along the pathway of tracks connecting two regions of interest defined by BrainSuite's BCI-DNI atlas. In general, we found lower FA values in anemic patients; indicating the loss of coherence in the main diffusion direction that potentially indicates WM injury. We saw a positive correlation between FA and hemoglobin in these same regions, suggesting that decreased WM microstructural integrity FA is highly driven by chronic hypoxia. The only connection that did not follow this pattern was the connectivity within the left middle-inferior temporal gyrus. Interestingly, more reductions in FA were observed in non-SCD patients (mainly along with intrahemispheric WM bundles and watershed areas) than the SCD patients (mainly interhemispheric).
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Affiliation(s)
- Clio González-Zacarías
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States,Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States,Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States,Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States,Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Chau Vu
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Botian Xu
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Jian Shen
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Anand A. Joshi
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States
| | - Richard M. Leahy
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - John C. Wood
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States,*Correspondence: John C. Wood
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Stotesbury H, Kawadler JM, Clayden JD, Saunders DE, Hood AM, Koelbel M, Sahota S, Rees DC, Wilkey O, Layton M, Pelidis M, Inusa BPD, Howard J, Chakravorty S, Clark CA, Kirkham FJ. Quantification of Silent Cerebral Infarction on High-Resolution FLAIR and Cognition in Sickle Cell Anemia. Front Neurol 2022; 13:867329. [PMID: 35847220 PMCID: PMC9277177 DOI: 10.3389/fneur.2022.867329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/27/2022] [Indexed: 01/18/2023] Open
Abstract
Research in sickle cell anemia (SCA) has used, with limited race-matched control data, binary categorization of patients according to the presence or absence of silent cerebral infarction (SCI). SCI have primarily been identified using low-resolution MRI, with radiological definitions varying in lesion length and the requirement for abnormality on both fluid attenuated inversion recovery (FLAIR) and T1-weighted images. We aimed to assess the effect of published SCI definitions on global, regional, and lobar lesion metrics and their value in predicting cognition. One hundred and six patients with SCA and 48 controls aged 8-30 years underwent 3T MRI with a high-resolution FLAIR sequence and Wechsler cognitive assessment. Prevalence, number, and volume of lesions were calculated using a semi-automated pipeline for SCI defined as: (1) Liberal: any length (L-SCI); (2) Traditional: >3 mm in greatest dimension (T-SCI); (3) Restrictive; >3 mm in greatest dimension with a corresponding T1-weighted hypo-intensity (R-SCI). Globally, as hypothesized, there were large effects of SCI definition on lesion metrics in patients and controls, with prevalence varying from 24-42% in patients, and 4-23% in controls. However, contrary to hypotheses, there was no effect of any global metric on cognition. Regionally, there was a consistent distribution of SCI in frontal and parietal deep and juxta-cortical regions across definitions and metrics in patients, but no consistent distribution in controls. Effects of regional SCI metrics on cognitive performance were of small magnitude; some were paradoxical. These findings expose the challenges associated with the widespread use of SCI presence as a biomarker of white-matter injury and cognitive dysfunction in cross-sectional high-resolution MRI studies in patients with SCA. The findings indicate that with high-resolution MRI: (1) radiological definitions have a large effect on resulting lesion groups, numbers, and volumes; (2) there is a non-negligible prevalence of lesions in young healthy controls; and (3) at the group-level, there is no cross-sectional association between global lesion metrics and general cognitive impairment irrespective of lesion definition and metric. With high-resolution multi-modal MRI, the dichotomy of presence or absence of SCI does not appear to be a sensitive biomarker for the detection of functionally significant pathology; the search for appropriate endpoints for clinical treatment trials should continue.
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Affiliation(s)
- Hanne Stotesbury
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jamie M Kawadler
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jonathan D Clayden
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Dawn E Saunders
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Anna M Hood
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Melanie Koelbel
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sati Sahota
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | - Olu Wilkey
- North Middlesex University Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark Layton
- Haematology, Imperial College Healthcare NHS Foundation Trust, London, United Kingdom
| | - Maria Pelidis
- Department of Haematology and Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Baba P D Inusa
- Department of Haematology and Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jo Howard
- Department of Haematology and Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Chris A Clark
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
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8
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Turner EM, Koskela-Staples MSN, Evans BSC, Black LV, Heaton SC, Fedele DA. The Role of Sleep-Disordered Breathing Symptoms in Neurocognitive Function Among Youth With Sickle Cell Disease1. Dev Neuropsychol 2022; 47:93-104. [PMID: 35157528 DOI: 10.1080/87565641.2022.2038601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine associations between sleep-disordered breathing (SDB) and executive/attentional function in pediatric sickle cell disease (SCD). METHODS Sixty youth with SCD ages 8-18 years and caregivers completed the Pediatric Sleep Questionnaire (PSQ), Delis Kaplan Executive Function System Trail Making Test (DKEFS TMT), Psychomotor Vigilance Test (PVT), and the Behavior Rating Inventory Of Executive Function, Second Edition (BRIEF-2) Parent Report. RESULTS The PSQ significantly predicted the BRIEF-2 Parent Report, F(1, 58) = 44.64, p < .001, R2 = 0.44, f2 = 0.77. CONCLUSIONS Sleep-disordered breathing symptoms may predict informant-rated executive dysfunction in pediatric SCD, but not performance-based executive function.
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Affiliation(s)
- Elise M Turner
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | | | - B S Corinne Evans
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | - L Vandy Black
- Division of Pediatric Hematology and Oncology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Shelley C Heaton
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
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9
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Alteration of grey matter volume is associated with pain and quality of life in children with sickle cell disease. Transl Res 2022; 240:17-25. [PMID: 34418575 DOI: 10.1016/j.trsl.2021.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/20/2022]
Abstract
Pain is the most common symptom experienced by patients with sickle cell disease (SCD) and is associated with poor quality of life. We investigated the association between grey matter volume (GMV) and the frequency of pain crises in the preceding 12 months and SCD-specific quality of life (QOL) assessed by the PedsQLTM SCD module in 38 pediatric patients with SCD. Using voxel-based morphometry methodology, high-resolution T1 structural scans were preprocessed using SPM and further analyzed in SPSS. The whole brain multiple regression analysis identified that perigenual anterior cingulate cortex (ACC) GMV was negatively associated with the frequency of pain crises (r = -0.656, P = 0.003). A two-group t-test analysis showed that the subgroup having pain crisis/crises in the past year also showed significantly lower GMV at left supratemporal gyrus than the group without any pain crisis (p=0.024). The further 21 pain-related regions of interest (ROI) analyses identified a negative correlation between pregenual ACC (r = -0.551, P = 0.001), subgenual ACC (r = -0.540, P = 0.001) and the frequency of pain crises. Additionally, the subgroup with poorer QOL displayed significantly reduced GMV in the parahippocampus (left: P = 0.047; right: P = 0.024). The correlations between the cerebral structural alterations and the accentuated pain experience and QOL suggests a possible role of central mechanisms in SCD pain.
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10
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Mayer SL, Fields ME, Hulbert ML. Neurologic and Cognitive Outcomes in Sickle Cell Disease from Infancy through Adolescence. Neoreviews 2021; 22:e531-e539. [PMID: 34341160 DOI: 10.1542/neo.22-8-e531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Children with sickle cell disease (SCD) are at risk for neurologic and cognitive complications beginning in early childhood. Current treatment for SCD focuses on primary prevention of complications, such as hydroxyurea for prevention of pain and acute chest syndrome, and chronic transfusion therapy for children who are at high risk for strokes. In this article, the prevalence, pathophysiology, and available interventions to prevent and treat neurologic and cognitive complications of SCD will be reviewed.
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Affiliation(s)
- Sarah L Mayer
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Melanie E Fields
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University in St Louis, St Louis, MO
| | - Monica L Hulbert
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University in St Louis, St Louis, MO
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11
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Connolly ME, Bills SE, Hardy SJ. Cognitive Functioning and Educational Support Plans in Youth With Sickle Cell Disease. J Pediatr Hematol Oncol 2021; 43:e666-e676. [PMID: 33625087 DOI: 10.1097/mph.0000000000002092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/31/2020] [Indexed: 11/26/2022]
Abstract
Children with sickle cell disease (SCD) face academic challenges because of direct and indirect disease-related events. This study examined the proportion of youth with SCD with educational plans and whether cognitive functioning is associated with educational support. Ninety-one youth (7 to 16 y) with SCD completed the WISC-V; caregivers reported educational support (504 Plan/Individualized Education Program) and completed the Behavior Rating Inventory of Executive Function. χ2 square and t test analyses explored whether overall intelligence (full-scale intelligence quotient [FSIQ]), relative weaknesses in processing speed and working memory (> 1SD below FSIQ), and parent-reported executive functioning were associated with educational plans. Participants with a FSIQ<90 were more likely to have support (74%) compared with youth with a FSIQ≥90 (47%; P=0.012). Those with FSIQ≥90 and FSIQ=80 to 89 were less likely to have support (47%, 58%, respectively) compared with those with FSIQ≤79 (89%; P=0.004). Relative weaknesses in processing speed were associated with educational support (83% vs. 52%, P=0.018) as well as behavioral aspects of executive functioning (Ps<0.05). Despite universal eligibility for a 504 Plan, 42% of youth with SCD in our sample did not have educational support. Significant deficits in intellectual functioning, processing speed, and parent-observed executive functioning are associated with having a plan, but children with subtle deficits seem less likely to be identified for educational support.
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Affiliation(s)
- Megan E Connolly
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, DC
| | - Sarah E Bills
- Department of Psychology, University of South Carolina, Columbia, SC
| | - Steven J Hardy
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, DC
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12
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Stotesbury H, Kawadler JM, Saunders DE, Kirkham FJ. MRI detection of brain abnormality in sickle cell disease. Expert Rev Hematol 2021; 14:473-491. [PMID: 33612034 PMCID: PMC8315209 DOI: 10.1080/17474086.2021.1893687] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/18/2021] [Indexed: 02/08/2023]
Abstract
Introduction: Over the past decades, neuroimaging studies have clarified that a significant proportion of patients with sickle cell disease (SCD) have functionally significant brain abnormalities. Clinically, structural magnetic resonance imaging (MRI) sequences (T2, FLAIR, diffusion-weighted imaging) have been used by radiologists to diagnose chronic and acute cerebral infarction (both overt and clinically silent), while magnetic resonance angiography and venography have been used to diagnose arteriopathy and venous thrombosis. In research settings, imaging scientists are increasingly applying quantitative techniques to shine further light on underlying mechanisms.Areas covered: From a June 2020 PubMed search of 'magnetic' or 'MRI' and 'sickle' over the previous 5 years, we selected manuscripts on T1-based morphometric analysis, diffusion tensor imaging, arterial spin labeling, T2-oximetry, quantitative susceptibility, and connectivity.Expert Opinion: Quantitative MRI techniques are identifying structural and hemodynamic biomarkers associated with risk of neurological and neurocognitive complications. A growing body of evidence suggests that these biomarkers are sensitive to change with treatments, such as blood transfusion and hydroxyurea, indicating that they may hold promise as endpoints in future randomized clinical trials of novel approaches including hemoglobin F upregulation, reduction of polymerization, and gene therapy. With further validation, such techniques may eventually also improve neurological and neurocognitive risk stratification in this vulnerable population.
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Affiliation(s)
- Hanne Stotesbury
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jamie Michelle Kawadler
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dawn Elizabeth Saunders
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Fenella Jane Kirkham
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, UK
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13
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Chai Y, Ji C, Coloigner J, Choi S, Balderrama M, Vu C, Tamrazi B, Coates T, Wood JC, O'Neil SH, Lepore N. Tract-specific analysis and neurocognitive functioning in sickle cell patients without history of overt stroke. Brain Behav 2021; 11:e01978. [PMID: 33434353 PMCID: PMC7994688 DOI: 10.1002/brb3.1978] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 10/05/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is a hereditary blood disorder in which the oxygen-carrying hemoglobin molecule in red blood cells is abnormal. SCD patients are at increased risks for strokes and neurocognitive deficit, even though neurovascular screening and treatments have lowered the rate of overt strokes. Tract-specific analysis (TSA) is a statistical method to evaluate microstructural WM damage in neurodegenerative disorders, using diffusion tensor imaging (DTI). METHODS We utilized TSA and compared 11 major brain WM tracts between SCD patients with no history of overt stroke, anemic controls, and healthy controls. We additionally examined the relationship between the most commonly used DTI metric of WM tracts and neurocognitive performance in the SCD patients and healthy controls. RESULTS Disruption of WM microstructure orientation-dependent metrics for the SCD patients was found in the genu of the corpus callosum (CC), cortico-spinal tract, inferior fronto-occipital fasciculus, right inferior longitudinal fasciculus, superior longitudinal fasciculus, and left uncinate fasciculus. Neurocognitive performance indicated slower processing speed and lower response inhibition skills in SCD patients compared to controls. TSA abnormalities in the CC were significantly associated with measures of processing speed, working memory, and executive functions. CONCLUSION Decreased DTI-derived metrics were observed on six tracts in chronically anemic patients, regardless of anemia subtype, while two tracks with decreased measures were unique to SCD patients. Patients with WMHs had more significant FA abnormalities. Decreased FA values in the CC significantly correlated with all nine neurocognitive tests, suggesting a critical importance for CC in core neurocognitive processes.
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Affiliation(s)
- Yaqiong Chai
- CIBORG LaboratoryDepartment of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Chaoran Ji
- CIBORG LaboratoryDepartment of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of Electrical EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Julie Coloigner
- CIBORG LaboratoryDepartment of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Division of CardiologyChildren's Hospital Los AngelesLos AngelesCAUSA
| | - Soyoung Choi
- Neuroscience Graduate ProgramUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Melissa Balderrama
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
- Division of Hematology, Oncology, and Blood and Marrow TransplantationChildren's Hospital Los AngelesLos AngelesCAUSA
| | - Chau Vu
- Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Benita Tamrazi
- Department of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
| | - Thomas Coates
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
- Division of Hematology, Oncology, and Blood and Marrow TransplantationChildren's Hospital Los AngelesLos AngelesCAUSA
| | - John C. Wood
- Division of CardiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Sharon H. O'Neil
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
- Division of NeurologyChildren's Hospital Los AngelesLos AngelesCAUSA
- The Saban Research InstituteChildren's Hospital Los AngelesLos AngelesCAUSA
| | - Natasha Lepore
- CIBORG LaboratoryDepartment of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
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14
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Mallon D, Doig D, Dixon L, Gontsarova A, Jan W, Tona F. Neuroimaging in Sickle Cell Disease: A Review. J Neuroimaging 2021; 30:725-735. [PMID: 33463866 DOI: 10.1111/jon.12766] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/22/2020] [Indexed: 11/28/2022] Open
Abstract
Sickle cell disease is the most common hereditary hemoglobinopathy, which results in abnormally shaped and rigid red blood cells. These sickle-shaped red blood cells cause vaso-occlusion and ischemic phenomena that can affect any organ in the body. As a common cause of disability, the neurological manifestations of sickle cell disease are particularly important. Neuroimaging has a crucial role in the diagnosis, management, and prevention of the complications of sickle cell disease. These complications can affect the brain parenchyma, vasculature, and skull and can be ascribed directly or indirectly to a vasculopathy of small and large vessels. Vaso-occlusion can cause ischemic stroke. Ischemic damage in the absence of an acute neurological deficit, and therefore only apparent on neuroimaging, is termed silent cerebral ischemia. Weakening of the arterial walls can cause aneurysms. In its most severe form, a vasculopathy of the terminal internal carotid arteries can progress to moyamoya syndrome, characterized by steno-occlusive disease and the formation of friable collateral arteries. Rupture of aneurysms or friable collateral arteries is a potential cause of intracranial hemorrhage. The skull and vertebrae may be affected by extra-medullary hematopoiesis, due to severe anemia, or iron deposition, due to chronic red blood cell transfusion. Impaired blood supply to bone is associated with osteomyelitis and osteonecrosis. Fat embolization syndrome is a rare complication of osteonecrosis, which may cause devastating neurological impairment. Awareness and early recognition of the diverse manifestations of sickle cell disease on neuroimaging is crucial to ensure optimal treatment in a complex patient cohort.
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Affiliation(s)
- Dermot Mallon
- Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - David Doig
- Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - Luke Dixon
- Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | | | - Wajanat Jan
- Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - Francesca Tona
- Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
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15
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Houwing ME, Grohssteiner RL, Dremmen MHG, Atiq F, Bramer WM, de Pagter APJ, Zwaan CM, White TJH, Vernooij MW, Cnossen MH. Silent cerebral infarcts in patients with sickle cell disease: a systematic review and meta-analysis. BMC Med 2020; 18:393. [PMID: 33349253 PMCID: PMC7754589 DOI: 10.1186/s12916-020-01864-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Silent cerebral infarcts (SCIs) are the most common neurological complication in children and adults with sickle cell disease (SCD). In this systematic review, we provide an overview of studies that have detected SCIs in patients with SCD by cerebral magnetic resonance imaging (MRI). We focus on the frequency of SCIs, the risk factors involved in their development and their clinical consequences. METHODS The databases of Embase, MEDLINE ALL via Ovid, Web of Science Core Collection, Cochrane Central Register of Trials via Wiley and Google Scholar were searched from inception to June 1, 2019. RESULTS The search yielded 651 results of which 69 studies met the eligibility criteria. The prevalence of SCIs in patients with SCD ranges from 5.6 to 80.6% with most studies reported in the 20 to 50% range. The pooled prevalence of SCIs in HbSS and HbSβ0 SCD patients is 29.5%. SCIs occur more often in patients with the HbSS and HbSβ0 genotype in comparison with other SCD genotypes, as SCIs are found in 9.2% of HbSC and HbSβ+ patients. Control subjects showed a mean pooled prevalence of SCIs of 9.8%. Data from included studies showed a statistically significant association between increasing mean age of the study population and mean SCI prevalence. Thirty-three studies examined the risk factors for SCIs. The majority of the risk factors show no clear association with prevalence, since more or less equal numbers of studies give evidence for and against the causal association. CONCLUSIONS This systematic review and meta-analysis shows SCIs are common in patients with SCD. No clear risk factors for their development were identified. Larger, prospective and controlled clinical, neuropsychological and neuroimaging studies are needed to understand how SCD and SCIs affect cognition.
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Affiliation(s)
- Maite E Houwing
- Department of Pediatric Haematology and Oncology, Erasmus MC - Sophia Children's Hospital, NC-825, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - Rowena L Grohssteiner
- Department of Pediatric Haematology and Oncology, Erasmus MC - Sophia Children's Hospital, NC-825, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Marjolein H G Dremmen
- Department of Pediatric Radiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ferdows Atiq
- Department of Haematology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Anne P J de Pagter
- Department of Pediatric Haematology and Oncology, Erasmus MC - Sophia Children's Hospital, NC-825, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - C Michel Zwaan
- Department of Pediatric Haematology and Oncology, Erasmus MC - Sophia Children's Hospital, NC-825, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Tonya J H White
- Department of Child and Adolescent Psychiatry, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Haematology and Oncology, Erasmus MC - Sophia Children's Hospital, NC-825, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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16
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Kaseka ML, Dlamini N, Westmacott R. Ischemic sequelae and other vascular diseases. HANDBOOK OF CLINICAL NEUROLOGY 2020; 173:485-492. [PMID: 32958192 DOI: 10.1016/b978-0-444-64150-2.00033-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although pediatric stroke is associated with higher survival rates compared with adult stroke, a substantial body of evidence indicates significant neuropsychologic morbidity in pediatric stroke survivors. Neuroplasticity does not guarantee good outcome in children. The general trends observed in the literature are reviewed as is the profile observed in common causes of pediatric stroke: congenital heart disease, moyamoya disease, and sickle cell disease. The neuropsychologic profile of pediatric stroke patients is heterogeneous due to the multiplicity of associated causes. Stroke in early infancy and large strokes are associated with cognitive impairment while more limited disorders, such as phasic deficit, are observed in childhood stroke. Executive dysfunction is common in pediatric stroke, but social interaction skills are usually preserved. Congenital heart disease and sickle cell disease are associated with global neuropsychologic dysfunction while cognition is usually preserved in moyamoya. Executive dysregulation is instead more frequently reported in this population. Further study of maladaptive processes after pediatric stroke will allow identification of predictors of functional and neuropsychologic outcomes and permit personalization of care.
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Affiliation(s)
- Matsanga Leyila Kaseka
- Department of Pediatrics, Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada.
| | - Nomazulu Dlamini
- Department of Pediatrics, Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Westmacott
- Department of Psychology, Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
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17
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Arfé B, Montanaro M, Mottura E, Scaltritti M, Manara R, Basso G, Sainati L, Colombatti R. Selective Difficulties in Lexical Retrieval and Nonverbal Executive Functioning in Children With HbSS Sickle Cell Disease. J Pediatr Psychol 2019; 43:666-677. [PMID: 29432593 DOI: 10.1093/jpepsy/jsy005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 01/17/2018] [Indexed: 11/14/2022] Open
Abstract
Language deficits in multilingual children with sickle cell disease (SCD) are poorly understood. We tested the hypothesis that selective language deficits in this population could relate to an impaired frontal lobe functioning often associated with high-risk homozygous HbS disease (HbSS). In all, 32 children from immigrant communities with HbSS SCD aged 6 to 12 years (mean age = 9.03, n = 9 with silent infarcts) and 35 demographically matched healthy controls (mean age = 9.14) were tested on their naming skills, phonological and semantic fluency, attention, and selected executive functions (response inhibition and planning skills). Analyses of variance showed significant differences between patients and controls in inhibition and planning (p = .001 and .001), and phonological fluency (p = .004). The poorer performance in phonological fluency of the children with SCD was not associated with any visible brain damage to language areas. Hierarchical regression analyses showed that, whereas the control children's vocabulary knowledge explained their performance in the phonological fluency tasks, only inhibition skills accounted for variance in the performance of the children with SCD. These results suggest a selective impairment of verbal and nonverbal executive functioning (i.e., planning, inhibition, and phonological fluency) in children with SCD, with deficits possibly owing to frontal area hypoxia.
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Affiliation(s)
- Barbara Arfé
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione-University of Padova
| | - Maria Montanaro
- Clinic of Pediatric Hematology Oncology, Azienda Ospedaliera-Università di Padova
| | - Elena Mottura
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione-University of Padova
| | - Michele Scaltritti
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione-University of Padova
| | | | - Giuseppe Basso
- Clinic of Pediatric Hematology Oncology, Azienda Ospedaliera-Università di Padova
| | - Laura Sainati
- Clinic of Pediatric Hematology Oncology, Azienda Ospedaliera-Università di Padova
| | - Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Azienda Ospedaliera-Università di Padova
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18
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Choi S, O'Neil SH, Joshi AA, Li J, Bush AM, Coates TD, Leahy RM, Wood JC. Anemia predicts lower white matter volume and cognitive performance in sickle and non-sickle cell anemia syndrome. Am J Hematol 2019; 94:1055-1065. [PMID: 31259431 DOI: 10.1002/ajh.25570] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 12/13/2022]
Abstract
Severe chronic anemia is an independent predictor of overt stroke, white matter damage, and cognitive dysfunction in the elderly. Severe anemia also predisposes to white matter strokes in young children, independent of the anemia subtype. We previously demonstrated symmetrically decreased white matter (WM) volumes in patients with sickle cell disease (SCD). In the current study, we investigated whether patients with non-sickle anemia also have lower WM volumes and cognitive dysfunction. Magnetic Resonance Imaging was performed on 52 clinically asymptomatic SCD patients (age = 21.4 ± 7.7; F = 27, M = 25; hemoglobin = 9.6 ± 1.6 g/dL), 26 non-sickle anemic patients (age = 23.9 ± 7.9; F = 14, M = 12; hemoglobin = 10.8 ± 2.5 g/dL) and 40 control subjects (age = 27.7 ± 11.3; F = 28, M = 12; hemoglobin = 13.4 ± 1.3 g/dL). Voxel-wise changes in WM brain volumes were compared to hemoglobin levels to identify brain regions that are vulnerable to anemia. White matter volume was diffusely lower in deep, watershed areas proportionally to anemia severity. After controlling for age, sex, and hemoglobin level, brain volumes were independent of disease. WM volume loss was associated with lower Full Scale Intelligence Quotient (FSIQ; P = .0048; r2 = .18) and an abnormal burden of silent cerebral infarctions (P = .029) in males, but not in females. Hemoglobin count and cognitive measures were similar between subjects with and without white-matter hyperintensities. The spatial distribution of volume loss suggests chronic hypoxic cerebrovascular injury, despite compensatory hyperemia. Neurocognitive consequences of WM volume changes and silent cerebral infarction were strongly sexually dimorphic. Understanding the possible neurological consequences of chronic anemia may help inform our current clinical practices.
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Affiliation(s)
- Soyoung Choi
- Neuroscience Graduate ProgramUniversity of Southern California Los Angeles California
- Signal and Image Processing InstituteUniversity of Southern California Los Angeles California
- Division of Hematology, Oncology and Blood and Marrow TransplantationChildren's Hospital Los Angeles Los Angeles California
| | - Sharon H. O'Neil
- The Saban Research Institute, Children's Hospital Los Angeles Los Angeles California
- Division of NeurologyChildren's Hospital Los Angeles Los Angeles California
- Department of Pediatrics, Keck School of MedicineUniversity of Southern California Los Angeles California
| | - Anand A. Joshi
- Signal and Image Processing InstituteUniversity of Southern California Los Angeles California
| | - Jian Li
- Signal and Image Processing InstituteUniversity of Southern California Los Angeles California
| | - Adam M. Bush
- Division of Hematology, Oncology and Blood and Marrow TransplantationChildren's Hospital Los Angeles Los Angeles California
- Biomedical EngineeringUniversity of Southern California Los Angeles California
- Radiology DepartmentStanford University Stanford California
| | - Thomas D. Coates
- Division of Hematology, Oncology and Blood and Marrow TransplantationChildren's Hospital Los Angeles Los Angeles California
- Department of Pediatrics, Keck School of MedicineUniversity of Southern California Los Angeles California
| | - Richard M. Leahy
- Neuroscience Graduate ProgramUniversity of Southern California Los Angeles California
- Signal and Image Processing InstituteUniversity of Southern California Los Angeles California
| | - John C. Wood
- Division of Hematology, Oncology and Blood and Marrow TransplantationChildren's Hospital Los Angeles Los Angeles California
- Department of Pediatrics, Keck School of MedicineUniversity of Southern California Los Angeles California
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19
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Abstract
OBJECTIVES Although pediatric obstructive sleep apnea (OSA) is estimated to affect 2-3% of the general population, its prevalence in sickle cell disease (SCD) is much higher, with research suggesting a prevalence rate of upwards of 40%. Despite the similar underlying pathophysiological mechanisms of neurocognitive effects in pediatric OSA and SCD, there is a scarcity of information on how these two conditions interact. The aim of this study was to better understand the contribution of sleep apnea to neurocognitive deficits in children diagnosed with SCD. METHOD This study assessed cognitive function in 26 children with comorbid SCD and OSA, 39 matched comparisons with SCD only, and 59 matched comparisons in children without a chronic health condition. RESULTS There were significant differences on measures of processing speed and reading decoding, with children without a chronic health condition scoring better than both chronic health condition groups. Additionally, the no chronic health condition group performed better on a test of quantitative knowledge and reasoning and a test of visual-spatial construction than the SCD-only group. Contrary to our hypotheses, there were no between-group differences suggesting an additive impact of OSA on cognition. Exploratory analyses revealed associations within the group that had OSA showing that more severe OSA correlated with lower performance on measures of processing speed and quantitative knowledge/reasoning. CONCLUSIONS Children with comorbid OSA and SCD do not present with greater deficits in cognitive functioning than children with SCD alone. However, severe OSA may confer additional risk for neurocognitive impairments.
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20
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Connolly ME, Bills SE, Hardy SJ. Neurocognitive and psychological effects of persistent pain in pediatric sickle cell disease. Pediatr Blood Cancer 2019; 66:e27823. [PMID: 31131984 DOI: 10.1002/pbc.27823] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/15/2019] [Accepted: 05/01/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pain is a major complication of sickle cell disease (SCD), spanning vaso-occlusive crises and persistent pain. Although it is known that persistent pain is associated with considerable impairment in youth without SCD, little is known about the functional effects of persistent pain in SCD. The current study aimed to (a) characterize persistent pain in youth with SCD and (b) determine the extent to which youth with SCD and persistent pain differ in disease morbidity, functional impairment, and neurocognitive and psychological functioning. PROCEDURE Eighty-nine participants (ages 7-16) and caregivers completed questionnaires (BRIEF [Behavior Rating Inventory of Executive Function], Conners-3 [Conners-third edition], and PedsQL™-SCD Module, where PedsQL is Pediatric Quality of Life Inventory). Participants completed neurocognitive tests WISC-V [Wechsler Intelligence Scale for Children-fifth edition], WJ-III [Woodcock Johnson Tests of Achievement-third edition], and WIAT-III [Wechsler Individual Achievement Test-third edition]). Youth were classified as having persistent pain if they reported daily pain for 7 days. Chi-square and independent sample t-test analyses were used to assess group differences (those with vs without persistent pain). RESULTS Patients with persistent pain (n = 18) reported lower health-related quality of life (P = .000). Caregivers were more likely to rate youth with persistent pain as having lower planning/organization abilities (P = .011) and clinically elevated symptoms of defiance/aggression and oppositional defiance (Ps = .00; .01). Patients with persistent pain demonstrated poorer working memory (P = .023) and processing speed (P = .027), and fewer demonstrating reading fluency abilities in the average or above range (P = .026). CONCLUSIONS Youth with SCD and persistent pain are at risk for psychosocial and neurocognitive impairments, suggesting that persistent pain may be an important indicator of disease burden. Furthermore, disease management may be enhanced by assessing cognitive and psychosocial functioning and incorporating interdisciplinary treatments addressing impairment associated with persistent pain.
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Affiliation(s)
- Megan E Connolly
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC.,Divisions of Hematology and Oncology, Children's National Health System, Washington, DC
| | - Sarah E Bills
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Steven J Hardy
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC.,Divisions of Hematology and Oncology, Children's National Health System, Washington, DC
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21
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Stotesbury H, Kawadler JM, Hales PW, Saunders DE, Clark CA, Kirkham FJ. Vascular Instability and Neurological Morbidity in Sickle Cell Disease: An Integrative Framework. Front Neurol 2019; 10:871. [PMID: 31474929 PMCID: PMC6705232 DOI: 10.3389/fneur.2019.00871] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/26/2019] [Indexed: 12/20/2022] Open
Abstract
It is well-established that patients with sickle cell disease (SCD) are at substantial risk of neurological complications, including overt and silent stroke, microstructural injury, and cognitive difficulties. Yet the underlying mechanisms remain poorly understood, partly because findings have largely been considered in isolation. Here, we review mechanistic pathways for which there is accumulating evidence and propose an integrative systems-biology framework for understanding neurological risk. Drawing upon work from other vascular beds in SCD, as well as the wider stroke literature, we propose that macro-circulatory hyper-perfusion, regions of relative micro-circulatory hypo-perfusion, and an exhaustion of cerebral reserve mechanisms, together lead to a state of cerebral vascular instability. We suggest that in this state, tissue oxygen supply is fragile and easily perturbed by changes in clinical condition, with the potential for stroke and/or microstructural injury if metabolic demand exceeds tissue oxygenation. This framework brings together recent developments in the field, highlights outstanding questions, and offers a first step toward a linking pathophysiological explanation of neurological risk that may help inform future screening and treatment strategies.
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Affiliation(s)
- Hanne Stotesbury
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Jamie M Kawadler
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Patrick W Hales
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Dawn E Saunders
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom.,Department of Radiology, Great Ormond Hospital, London, United Kingdom
| | - Christopher A Clark
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom.,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom.,Department of Child Health, University Hospital Southampton, Southampton, United Kingdom.,Department of Paediatric Neurology, Kings College Hospital NHS Foundation Trust, London, United Kingdom
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22
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Chai Y, Bush AM, Coloigner J, Nederveen AJ, Tamrazi B, Vu C, Choi S, Coates TD, Lepore N, Wood JC. White matter has impaired resting oxygen delivery in sickle cell patients. Am J Hematol 2019; 94:467-474. [PMID: 30697803 PMCID: PMC6874897 DOI: 10.1002/ajh.25423] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/27/2018] [Accepted: 01/22/2019] [Indexed: 12/13/2022]
Abstract
Although modern medical management has lowered overt stroke occurrence in patients with sickle cell disease (SCD), progressive white matter (WM) damage remains common. It is known that cerebral blood flow (CBF) increases to compensate for anemia, but sufficiency of cerebral oxygen delivery, especially in the WM, has not been systematically investigated. Cerebral perfusion was measured by arterial spin labeling in 32 SCD patients (age range: 10-42 years old, 14 males, 7 with HbSC, 25 HbSS) and 25 age and race-matched healthy controls (age range: 15-45 years old, 10 males, 12 with HbAS, 13 HbAA); 8/24 SCD patients were receiving regular blood transfusions and 14/24 non-transfused SCD patients were taking hydroxyurea. Imaging data from control subjects were used to calculate maps for CBF and oxygen delivery in SCD patients and their T-score maps. Whole brain CBF was increased in SCD patients with a mean T-score of 0.5 and correlated with lactate dehydrogenase (r2 = 0.58, P < 0.0001). When corrected for oxygen content and arterial saturation, whole brain and gray matter (GM) oxygen delivery were normal in SCD, but WM oxygen delivery was 35% lower than in controls. Age and hematocrit were the strongest predictors for WM CBF and oxygen delivery in patients with SCD. There was spatial co-localization between regions of low oxygen delivery and WM hyperintensities on T2 FLAIR imaging. To conclude, oxygen delivery is preserved in the GM of SCD patients, but is decreased throughout the WM, particularly in areas prone to WM silent strokes.
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Affiliation(s)
- Yaqiong Chai
- Department of Biomedical Engineering, University of Southern California Engineering, School, Los Angeles, California
| | - Adam M. Bush
- Department of Radiology, Stanford, University, California
| | - Julie Coloigner
- Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, VISAGES - ERL U 1228, Rennes, France
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Benita Tamrazi
- Department of Radiology and Nuclear Medicine, Children’s Hospital Los Angeles,Los Angeles, California
| | - Chau Vu
- Department of Biomedical Engineering, University of Southern California Engineering, School, Los Angeles, California
| | - Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California
- Division of Cardiology, Children’s Hospital Los Angeles, Los Angeles, California
| | - Thomas D. Coates
- Section of Hematology, Children’s Hospital Los Angeles, Los Angeles, California
| | - Natasha Lepore
- Department of Biomedical Engineering, University of Southern California Engineering, School, Los Angeles, California
- Department of Radiology and Nuclear Medicine, Children’s Hospital Los Angeles,Los Angeles, California
| | - John C. Wood
- Department of Biomedical Engineering, University of Southern California Engineering, School, Los Angeles, California
- Division of Cardiology, Children’s Hospital Los Angeles, Los Angeles, California
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Ford AL, Ragan DK, Fellah S, Binkley MM, Fields ME, Guilliams KP, An H, Jordan LC, McKinstry RC, Lee JM, DeBaun MR. Silent infarcts in sickle cell disease occur in the border zone region and are associated with low cerebral blood flow. Blood 2018; 132:1714-1723. [PMID: 30061156 PMCID: PMC6194388 DOI: 10.1182/blood-2018-04-841247] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 07/17/2018] [Indexed: 11/20/2022] Open
Abstract
Silent cerebral infarcts (SCIs) are associated with cognitive impairment in sickle cell anemia (SCA). SCI risk factors include low hemoglobin and elevated systolic blood pressure; however, mechanisms underlying their development are unclear. Using the largest prospective study evaluating SCIs in pediatric SCA, we identified brain regions with increased SCI density. We tested the hypothesis that infarct density is greatest within regions in which cerebral blood flow is lowest, further restricting cerebral oxygen delivery in the setting of chronic anemia. Neuroradiology and neurology committees reached a consensus of SCIs in 286 children in the Silent Infarct Transfusion (SIT) Trial. Each infarct was outlined and coregistered to a brain atlas to create an infarct density map. To evaluate cerebral blood flow as a function of infarct density, pseudocontinuous arterial spin labeling was performed in an independent pediatric SCA cohort. Blood flow maps were aligned to the SIT Trial infarct density map. Mean blood flow within low, moderate, and high infarct density regions from the SIT Trial were compared. Logistic regression evaluated clinical and imaging predictors of overt stroke at 3-year follow-up. The SIT Trial infarct density map revealed increased SCI density in the deep white matter of the frontal and parietal lobes. A relatively small region, measuring 5.6% of brain volume, encompassed SCIs from 90% of children. Cerebral blood flow was lowest in the region of highest infarct density (P < .001). Baseline infarct volume and reticulocyte count predicted overt stroke. In pediatric SCA, SCIs are symmetrically located in the deep white matter where minimum cerebral blood flow occurs.
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Affiliation(s)
| | | | | | | | | | | | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO; and
| | - Lori C Jordan
- Department of Pediatrics, Vanderbilt University, Nashville, TN
| | - Robert C McKinstry
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO; and
| | - Jin-Moo Lee
- Department of Neurology
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO; and
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24
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Abstract
OBJECTIVES Children with sickle cell anemia (SCA) are commonly reported to experience executive dysfunction. However, the development of executive function (EF) in preschool-age children without stroke in this patient population has not been investigated so it is unclear when and how these deficits emerge. METHODS This case-control study examines the feasibility of assessing the early development of executive functioning in 22 preschool children years with SCA in the domains of processing speed, working memory, attention, inhibitory control, and cognitive flexibility, as well as everyday function, in comparison to matched control children. RESULTS A pattern of potential deficits in early emerging executive skills was observed in the domains of inhibitory control and cognitive flexibility. Parents reported no differences for everyday EF and no significant differences were observed for working memory and processing speed. CONCLUSIONS Results suggest that deficits in everyday executive difficulties, working memory, and processing speed, as commonly reported for older children with SCA, may not yet have emerged at this early developmental stage, despite specific deficits in cognitive flexibility and inhibitory control on behavioral measures. The feasibility of using available executive measures with preschool age children to characterize the development of early EF skills is discussed. (JINS, 2018, 24, 949-954).
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Downes M, Kirkham FJ, Berg C, Telfer P, de Haan M. Executive performance on the preschool executive task assessment in children with sickle cell anemia and matched controls. Child Neuropsychol 2018; 25:278-285. [PMID: 29954249 DOI: 10.1080/09297049.2018.1491962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Executive deficits are commonly reported in children with sickle cell anemia. Earlier identification of executive deficits would give more scope for intervention, but this cognitive domain has not been routinely investigated due to a lack of age-appropriate tasks normed for preschool children. In particular, information relating to patient performance on an executive task that reflects an everyday activity in the classroom could provide important insight and practical recommendations for the classroom teacher at this key developmental juncture as they enter the academic domain. The performance of 22 children with sickle cell anemia was compared to 24 matched control children on the Preschool Executive Task Assessment. Findings reveal that children with sickle cell anemia are performing poorer than their matched peers on this multi-step assessment. In particular, children with sickle cell anemia required more structured support to shift focus after a completed step, as reflected by poorer scores in the quantitative Sequencing and Completion domains. They also required more support to stay on task, as seen by poorer ratings in the qualitative Distractibility domain. Abbreviations:PETA: Preschool Executive Task Assessment; SCA: Sickle Cell Anemia; EF: Executive Functioning.
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Affiliation(s)
- Michelle Downes
- a School of Psychology , University College Dublin , Dublin , Ireland.,b Developmental Neurosciences , UCL Great Ormond Street Institute of Child Health , London , UK
| | - Fenella J Kirkham
- b Developmental Neurosciences , UCL Great Ormond Street Institute of Child Health , London , UK
| | - Christine Berg
- c School of Medicine , Washington University in St. Louis , MO , USA
| | - Paul Telfer
- d Barts Health NHS Trust , Royal London Hospital , London , UK
| | - Michelle de Haan
- b Developmental Neurosciences , UCL Great Ormond Street Institute of Child Health , London , UK
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26
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Fields ME, Guilliams KP, Ragan DK, Binkley MM, Eldeniz C, Chen Y, Hulbert ML, McKinstry RC, Shimony JS, Vo KD, Doctor A, An H, Ford AL, Lee JM. Regional oxygen extraction predicts border zone vulnerability to stroke in sickle cell disease. Neurology 2018; 90:e1134-e1142. [PMID: 29500287 PMCID: PMC5880632 DOI: 10.1212/wnl.0000000000005194] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 12/05/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine mechanisms underlying regional vulnerability to infarction in sickle cell disease (SCD) by measuring voxel-wise cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen utilization (CMRO2) in children with SCD. METHODS Participants underwent brain MRIs to measure voxel-based CBF, OEF, and CMRO2. An infarct heat map was created from an independent pediatric SCD cohort with silent infarcts and compared to prospectively obtained OEF maps. RESULTS Fifty-six participants, 36 children with SCD and 20 controls, completed the study evaluation. Whole-brain CBF (99.2 vs 66.3 mL/100 g/min, p < 0.001), OEF (42.7% vs 28.8%, p < 0.001), and CMRO2 (3.7 vs 2.5 mL/100 g/min, p < 0.001) were higher in the SCD cohort compared to controls. A region of peak OEF was identified in the deep white matter in the SCD cohort, delineated by a ratio map of average SCD to control OEF voxels. CMRO2 in this region, which encompassed the CBF nadir, was low relative to all white matter (p < 0.001). Furthermore, this peak OEF region colocalized with regions of greatest infarct density derived from an independent SCD cohort. CONCLUSIONS Elevated OEF in the deep white matter identifies a signature of metabolically stressed brain tissue at increased stroke risk in pediatric patients with SCD. We propose that border zone physiology, exacerbated by chronic anemic hypoxia, explains the high risk in this region.
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Affiliation(s)
- Melanie E Fields
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Kristin P Guilliams
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Dustin K Ragan
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Michael M Binkley
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Cihat Eldeniz
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Yasheng Chen
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Monica L Hulbert
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Robert C McKinstry
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Joshua S Shimony
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Katie D Vo
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Allan Doctor
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Hongyu An
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Andria L Ford
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Jin-Moo Lee
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO.
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Guilliams KP, Fields ME, Ragan DK, Eldeniz C, Binkley MM, Chen Y, Comiskey LS, Doctor A, Hulbert ML, Shimony JS, Vo KD, McKinstry RC, An H, Lee JM, Ford AL. Red cell exchange transfusions lower cerebral blood flow and oxygen extraction fraction in pediatric sickle cell anemia. Blood 2018; 131:1012-1021. [PMID: 29255068 PMCID: PMC5833262 DOI: 10.1182/blood-2017-06-789842] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/04/2017] [Indexed: 01/13/2023] Open
Abstract
Blood transfusions are the mainstay of stroke prevention in pediatric sickle cell anemia (SCA), but the physiology conferring this benefit is unclear. Cerebral blood flow (CBF) and oxygen extraction fraction (OEF) are elevated in SCA, likely compensating for reduced arterial oxygen content (CaO2). We hypothesized that exchange transfusions would decrease CBF and OEF by increasing CaO2, thereby relieving cerebral oxygen metabolic stress. Twenty-one children with SCA receiving chronic transfusion therapy (CTT) underwent magnetic resonance imaging before and after exchange transfusions. Arterial spin labeling and asymmetric spin echo sequences measured CBF and OEF, respectively, which were compared pre- and posttransfusion. Volumes of tissue with OEF above successive thresholds (36%, 38%, and 40%), as a metric of regional metabolic stress, were compared pre- and posttransfusion. Transfusions increased hemoglobin (Hb; from 9.1 to 10.3 g/dL; P < .001) and decreased Hb S (from 39.7% to 24.3%; P < .001). Transfusions reduced CBF (from 88 to 82.4 mL/100 g per minute; P = .004) and OEF (from 34.4% to 31.2%; P < .001). At all thresholds, transfusions reduced the volume of peak OEF found in the deep white matter, a location at high infarct risk in SCA (P < .001). Reduction of elevated CBF and OEF, both globally and regionally, suggests that CTT mitigates infarct risk in pediatric SCA by relieving cerebral metabolic stress at patient- and tissue-specific levels.
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Affiliation(s)
| | | | | | - Cihat Eldeniz
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO; and
| | - Michael M Binkley
- Department of Mechanical Engineering and Material Science, Washington University in St. Louis, St. Louis, MO
| | | | | | | | | | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO; and
| | - Katie D Vo
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO; and
| | - Robert C McKinstry
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO; and
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO; and
| | - Jin-Moo Lee
- Department of Neurology
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO; and
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28
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Corvest V, Blais S, Dahmani B, De Tersant M, Etienney AC, Maroni A, Ormières C, Roussel A, Pondarré C. [Cerebral vasculopathy in children with sickle cell disease: Key issues and the latest data]. Arch Pediatr 2017; 25:63-71. [PMID: 29254735 DOI: 10.1016/j.arcped.2017.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/07/2017] [Accepted: 11/04/2017] [Indexed: 10/18/2022]
Abstract
Cerebral vasculopathy is a common and severe complication of sickle cell disease in children. The pathophysiology consists of progressive damage to the basal intracranial arteries and cerebral microcirculation, while chronic anemia worsens exposure to cerebral hypoxia. It results in stroke and subclinical or poorly symptomatic ischemic lesions. Many clinical, biological, and radiological risk factors have been identified. The prevention strategy through systematic transcranial Doppler screening of large-vessel vasculopathy has revolutionized the management of this disease and has greatly decreased the risk of developing stroke. MRI-MRA is a complementary diagnostic tool for anatomical analysis of parenchymal and vascular lesions, which is used for chronic disease monitoring or in the context of an acute neurological event. New exploration opportunities are offered by submandibular Doppler sonography and indirect evaluation methods of cerebral oxygenation and perfusion. If chronic blood transfusion therapy is used to prevent the occurrence and recurrence of cerebral complications of sickle cell disease, only allogeneic hematopoietic stem cell transplantation can safely and definitively stop the transfusion program. It should therefore be proposed early, before irreversible cerebral or vascular lesions occur. Hydroxycarbamide treatment has recently emerged as a potential substitute for chronic transfusions for the maintenance of transcranial Doppler velocities, but only after an initial treatment by transfusions and provided there is close follow-up. In the long run, cerebral vascular damage can cause progressive cognitive impairment and disability, even in children without radiologically identified lesions, indicating the importance of systematic and repeated neuropsychological testing.
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Affiliation(s)
- V Corvest
- Assistance publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75004 Paris, France
| | - S Blais
- Assistance publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75004 Paris, France
| | - B Dahmani
- Assistance publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75004 Paris, France
| | - M De Tersant
- Assistance publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75004 Paris, France
| | - A-C Etienney
- Assistance publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75004 Paris, France
| | - A Maroni
- Assistance publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75004 Paris, France
| | - C Ormières
- Assistance publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75004 Paris, France
| | - A Roussel
- Assistance publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75004 Paris, France
| | - C Pondarré
- Université Paris-XII, centre hospitalier intercommunal de Créteil (CHIC), service de pédiatrie, 40, avenue de Verdun, 94000 Créteil, France.
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29
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Downes M, Kirkham FJ, Telfer PT, de Haan M. Altered Neurophysiological Processing of Auditory Attention in Preschool Children With Sickle Cell Disease. J Pediatr Psychol 2017; 43:856-869. [DOI: 10.1093/jpepsy/jsx115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 08/24/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michelle Downes
- School of Psychology, University College Dublin
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health
| | - Paul T Telfer
- Department of Haematology, Royal London hospital, Barts Health NHS Trust
| | - Michelle de Haan
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health
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30
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Sun B, Brown RC, Burns TG, Murdaugh D, Palasis S, Jones RA. Differences in Activation and Deactivation in Children with Sickle Cell Disease Compared with Demographically Matched Controls. AJNR Am J Neuroradiol 2017; 38:1242-1247. [PMID: 28408626 DOI: 10.3174/ajnr.a5170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Declines in both functional activation and functional connectivity have been reported in patients with sickle cell disease. In this study, we derived the functional and default mode responses to a word stem paradigm in age-, ethnicity-, and background-matched subjects with sickle cell disease and control groups, with the aim of testing whether both networks were similarly attenuated and whether the changes were related to physiologic parameters that characterize sickle cell disease. MATERIALS AND METHODS Both the functional and default mode responses were obtained from age- and background-matched controls and the sickle cell population by using a visually presented word stem paradigm on a 3T scanner. RESULTS We observed an attenuated response to both activation and deactivation in the sickle cell disease group. There were no significant differences in the activation response between the 2 groups for the contrast control > sickle cell disease; however, significant differences were observed in the medial parietal cortex, the auditory cortex, and the angular gyrus for the default mode. For the sickle cell group, a significant correlation between the activation z scores and the physiologic parameters was observed; for the deactivation, the results were not significant but the trend was similar. CONCLUSIONS The results indicate that the physiologic parameters modulate the activation in the expected fashion, but that the effect was weaker for deactivation. Given that significant differences between the 2 groups were only seen for deactivation, additional factors must modulate the deactivation in sickle cell disease.
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Affiliation(s)
- B Sun
- From the Departments of Radiology (B.S., S.P., R.A.J.)
| | | | - T G Burns
- Neuropsychology (T.G.B., D.M.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | - D Murdaugh
- Neuropsychology (T.G.B., D.M.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | - S Palasis
- From the Departments of Radiology (B.S., S.P., R.A.J.)
| | - R A Jones
- From the Departments of Radiology (B.S., S.P., R.A.J.)
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Choi S, Bush AM, Borzage MT, Joshi AA, Mack WJ, Coates TD, Leahy RM, Wood JC. Hemoglobin and mean platelet volume predicts diffuse T1-MRI white matter volume decrease in sickle cell disease patients. NEUROIMAGE-CLINICAL 2017; 15:239-246. [PMID: 28540180 PMCID: PMC5430155 DOI: 10.1016/j.nicl.2017.04.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/13/2017] [Accepted: 04/25/2017] [Indexed: 02/01/2023]
Abstract
Sickle cell disease (SCD) is a life-threatening genetic condition. Patients suffer from chronic systemic and cerebral vascular disease that leads to early and cumulative neurological damage. Few studies have quantified the effects of this disease on brain morphometry and even fewer efforts have been devoted to older patients despite the progressive nature of the disease. This study quantifies global and regional brain volumes in adolescent and young adult patients with SCD and racially matched controls with the aim of distinguishing between age related changes associated with normal brain maturation and damage from sickle cell disease. T1 weighted images were acquired on 33 clinically asymptomatic SCD patients (age = 21.3 ± 7.8; F = 18, M = 15) and 32 racially matched control subjects (age = 24.4 ± 7.5; F = 22, M = 10). Exclusion criteria included pregnancy, previous overt stroke, acute chest, or pain crisis hospitalization within one month. All brain volume comparisons were corrected for age and sex. Globally, grey matter volume was not different but white matter volume was 8.1% lower (p = 0.0056) in the right hemisphere and 6.8% (p = 0.0068) in the left hemisphere in SCD patients compared with controls. Multivariate analysis retained hemoglobin (β = 0.33; p = 0.0036), sex (β = 0.35; p = 0.0017) and mean platelet volume (β = 0.27; p = 0.016) as significant factors in the final prediction model for white matter volume for a combined r2 of 0.37 (p < 0.0001). Lower white matter volume was confined to phylogenetically younger brain regions in the anterior and middle cerebral artery distributions. Our findings suggest that there are diffuse white matter abnormalities in SCD patients, especially in the frontal, parietal and temporal lobes, that are associated with low hemoglobin levels and mean platelet volume. The pattern of brain loss suggests chronic microvascular insufficiency and tissue hypoxia as the causal mechanism. However, longitudinal studies of global and regional brain morphometry can help us give further insights on the pathophysiology of SCD in the brain. Total white matter brain volume is decreased in sickle cell disease patients. Global white matter decrease is found to be due to anemia. Diffuse WM volume decrease is found especially in watershed areas. Diffuse WM volume decrease spatially colocalize with silent stroke in SCD patients.
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Key Words
- ACA, anterior cerebral artery
- GM, grey matter
- Hemoglobin
- HgB, hemoglobin
- MCA, middle cerebral artery
- MPV, mean platelet volume
- MRI, magnetic resonance imaging
- Mean platelet volume
- PCA, posterior cerebral artery
- ROI, region of interest
- SCD, sickle cell disease
- Sickle cell disease
- Structural MRI
- WM, white matter
- WMHI, white matter hyperintensities
- White matter
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Affiliation(s)
- Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, 3641 Watt Way, HNB 120, Los Angeles, CA 90089-2520, USA; Signal and Image Processing Institution, University of Southern California, 3740 McClintock Avenue, EEB 400, Los Angeles, CA 90089-2560, USA; Department of Pediatrics and Radiology, Children's Hospital Los Angeles USC, 4650 Sunset Blvd., MS #81, Los Angeles, CA 90027, USA.
| | - Adam M Bush
- Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA 90089, USA.
| | - Matthew T Borzage
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles USC, 4650 Sunset Blvd., MS #81, Los Angeles, CA 90027, USA.
| | - Anand A Joshi
- Signal and Image Processing Institution, University of Southern California, 3740 McClintock Avenue, EEB 400, Los Angeles, CA 90089-2560, USA.
| | - William J Mack
- Department of Neurosurgery, University of Southern California Keck School of Medicine, 1200 North State St., Suite 3300, Los Angeles, CA 90033, USA.
| | - Thomas D Coates
- Hematology/Oncology, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #54, Los Angeles, CA 90027, USA.
| | - Richard M Leahy
- Signal and Image Processing Institution, University of Southern California, 3740 McClintock Avenue, EEB 400, Los Angeles, CA 90089-2560, USA; Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA 90089, USA.
| | - John C Wood
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles USC, 4650 Sunset Blvd., MS #81, Los Angeles, CA 90027, USA; Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA 90089, USA.
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Guilliams KP, Fields ME, Ragan DK, Chen Y, Eldeniz C, Hulbert ML, Binkley MM, Rhodes JN, Shimony JS, McKinstry RC, Vo K, An H, Lee JM, Ford AL. Large-Vessel Vasculopathy in Children With Sickle Cell Disease: A Magnetic Resonance Imaging Study of Infarct Topography and Focal Atrophy. Pediatr Neurol 2017; 69:49-57. [PMID: 28159432 PMCID: PMC5365370 DOI: 10.1016/j.pediatrneurol.2016.11.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/16/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Large-vessel vasculopathy (LVV) increases stroke risk in pediatric sickle cell disease beyond the baseline elevated stroke risk in this vulnerable population. The mechanisms underlying this added risk and its unique impact on the developing brain are not established. METHODS We analyzed magnetic resonance imaging and angiography scans of 66 children with sickle cell disease and infarcts by infarct density heatmaps and Jacobian determinants, a metric utilized to delineate focal volume change, to investigate if infarct location, volume, frequency, and cerebral atrophy differed among hemispheres with and without LVV. RESULTS Infarct density heatmaps demonstrated infarct "hot spots" within the deep white matter internal border zone region in both LVV and non-LVV hemispheres, but with greater infarct density and larger infarct volumes in LVV hemispheres (2.2 mL versus 0.25 mL, P < 0.001). Additional scattered cortical infarcts in the internal carotid artery territory occurred in LVV hemispheres, but were rare in non-LVV hemispheres. Jacobian determinants revealed greater atrophy in gray and white matter of the parietal lobes of LVV compared with non-LVV hemispheres. CONCLUSION Large-vessel vasculopathy in sickle cell disease appears to increase ischemic vulnerability in the borderzone region, as demonstrated by the increased frequency and extent of infarction within deep white matter, and increased risk of focal atrophy. Scattered infarctions across the LVV-affected hemispheres suggest additional stroke etiologies of vasculopathy (i.e., thromboembolism) in addition to chronic hypoxia-ischemia.
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Affiliation(s)
- Kristin P Guilliams
- Department of Neurology, Washington University School of Medicine,Department of Pediatrics, Washington University School of Medicine
| | - Melanie E Fields
- Department of Pediatrics, Washington University School of Medicine
| | - Dustin K Ragan
- Department of Neurology, Washington University School of Medicine
| | - Yasheng Chen
- Department of Neurology, Washington University School of Medicine
| | - Cihat Eldeniz
- Department of Radiology, Washington University School of Medicine
| | - Monica L Hulbert
- Department of Pediatrics, Washington University School of Medicine
| | | | | | - Joshua S Shimony
- Department of Pediatrics, Washington University School of Medicine,Department of Radiology, Washington University School of Medicine
| | - Robert C McKinstry
- Department of Pediatrics, Washington University School of Medicine,Department of Radiology, Washington University School of Medicine
| | - Katie Vo
- Department of Radiology, Washington University School of Medicine
| | - Hongyu An
- Department of Radiology, Washington University School of Medicine
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri; Department of Radiology, Washington University School of Medicine, Saint Louis, Missouri.
| | - Andria L Ford
- Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri.
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Enhanced Long-Term Brain Magnetic Resonance Imaging Evaluation of Children with Sickle Cell Disease after Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2017; 23:670-676. [PMID: 28089760 DOI: 10.1016/j.bbmt.2017.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/03/2017] [Indexed: 11/23/2022]
Abstract
Progressive neurovasculopathy in children with sickle cell disease (SCD) results in decreased cognitive function and quality of life (QoL). Hematopoietic cell transplantation (HCT) is believed to halt progression of neurovasculopathy. Quantitative analysis of T2-weighted fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) for white matter hyperintensity (WMH) burden provides a meaningful estimate of small vessel cerebrovascular disease. We asked if quantitative analysis of WMH could complement standardized clinical assessment of MRI/magnetic resonance angiography (MRA) for assessing SCD central nervous system vasculopathy before and after HCT. Retrospective longitudinal clinical examination of scheduled annual MRI/MRA and quantitative analysis of WMH were performed before and 1 to 7 years after HCT at scheduled annual intervals, along with QoL measurements, in children who had engrafted after HCT. Of 18 patients alive and persistently engrafted (median age, 9.1 years), pretransplantation MRI demonstrated that 9 and 5 had sickle-related stroke and/or small infarcts, respectively. Patients were divided into WMH severity tertiles based on pretransplantation WMH volumes. MRI and WMH were assessed 1 to 7 years after HCT. MRI/MRA and WMH volume were stable or slightly better in 17 of 18 patients. By parent- and self-report, post-HCT QoL improved for children in the lowest WMH tertile significantly more than in the other groups. Based on this single-institution retrospective sample, we report that WMH appears to quantitatively support MRI-based findings that HCT stabilizes long-term small and large vessel cerebrovascular changes and is associated with the degree of improved QoL. While confirmation in larger prospective studies and evaluation by neurocognitive testing are needed, these findings suggest that WMH is a useful biomarker of neurovasculopathy after transplantation for SCD.
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Kawadler JM, Clayden JD, Clark CA, Kirkham FJ. Intelligence quotient in paediatric sickle cell disease: a systematic review and meta-analysis. Dev Med Child Neurol 2016; 58:672-9. [PMID: 27038278 DOI: 10.1111/dmcn.13113] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2016] [Indexed: 11/29/2022]
Abstract
AIM Sickle cell disease (SCD) is the commonest cause of childhood stroke worldwide. Magnetic resonance imaging (MRI) is routinely used to detect additional silent cerebral infarction (SCI), as IQ is lower in SCI as well as stroke. This review assesses the effect of infarction on IQ, and specifically whether, compared to healthy controls, IQ differences are seen in children with SCI with no apparent MRI abnormality. METHOD A systematic review was conducted to include articles with an SCD paediatric population, MRI information, and Wechsler IQ. A meta-analysis of 19 articles was performed to compare IQ in three groups: stroke vs SCI; SCI vs no SCI; and no SCI vs healthy controls. RESULTS Mean differences in IQ between all three groups were significant: stroke patients had lower IQ than patients with SCI by 10 points (six studies); patients with SCI had lower IQ than no patients with SCI by 6 points (17 studies); and no patients with SCI had lower IQ than healthy controls by 7 points (seven studies). INTERPRETATION Children with SCD and no apparent MRI abnormality have significantly lower IQ than healthy controls. In this chronic condition, other biological, socioeconomic, and environmental factors must play a significant role in cognition.
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Affiliation(s)
- Jamie M Kawadler
- Developmental Neurosciences, Institute of Child Health, University College London, London, UK
| | - Jonathan D Clayden
- Developmental Neurosciences, Institute of Child Health, University College London, London, UK
| | - Chris A Clark
- Developmental Neurosciences, Institute of Child Health, University College London, London, UK
| | - Fenella J Kirkham
- Developmental Neurosciences, Institute of Child Health, University College London, London, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK
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35
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Kawadler JM, Clark CA, McKinstry RC, Kirkham FJ. Brain atrophy in paediatric sickle cell anaemia: findings from the silent infarct transfusion (SIT) trial. Br J Haematol 2016; 177:151-153. [PMID: 27061199 DOI: 10.1111/bjh.14039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jamie M Kawadler
- Developmental Neurosciences, UCL Institute of Child Health, London, UK
| | - Chris A Clark
- Developmental Neurosciences, UCL Institute of Child Health, London, UK
| | - Robert C McKinstry
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Institute of Child Health, London, UK
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Chai Y, Coloigner J, Qu X, Choi S, Bush A, Borzage M, Vu C, Lepore N, Wood J. Tract specific analysis in patients with sickle cell disease. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2015; 9681. [PMID: 30344363 DOI: 10.1117/12.2213617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Sickle cell disease (SCD) is a hereditary blood disorder in which the oxygen-carrying hemoglobin molecule in red blood cells is abnormal. It affects numerous people in the world and leads to a shorter life span, pain, anemia, serious infections and neurocognitive decline. Tract-Specific Analysis (TSA) is a statistical method to evaluate white matter alterations due to neurocognitive diseases, using diffusion tensor magnetic resonance images. Here, for the first time, TSA is used to compare 11 major brain white matter (WM) tracts between SCD patients and age-matched healthy subjects. Alterations are found in the corpus callosum (CC), the cortico-spinal tract (CST), inferior fronto-occipital fasciculus (IFO), inferior longitudinal fasciculus (ILF), superior longitudinal fasciculus (SLF), and uncinated fasciculus (UNC). Based on previous studies on the neurocognitive functions of these tracts, the significant areas found in this paper might be related to several cognitive impairments and depression, both of which are observed in SCD patients.
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Affiliation(s)
- Yaqiong Chai
- CIBORG laboratory, Department of Radiology, Children's Hospital Los Angeles, CA, USA.,Division of Cardiology, Children's Hospital Los Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern California, CA, USA
| | - Julie Coloigner
- CIBORG laboratory, Department of Radiology, Children's Hospital Los Angeles, CA, USA.,Division of Cardiology, Children's Hospital Los Angeles, CA, USA
| | - Xiaoping Qu
- CIBORG laboratory, Department of Radiology, Children's Hospital Los Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern California, CA, USA
| | - Soyoung Choi
- Division of Cardiology, Children's Hospital Los Angeles, CA, USA
| | - Adam Bush
- Division of Cardiology, Children's Hospital Los Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern California, CA, USA
| | - Matt Borzage
- Department of Neonatology, Children's Hospital Los Angeles, CA, USA
| | - Chau Vu
- Division of Cardiology, Children's Hospital Los Angeles, CA, USA
| | - Natasha Lepore
- CIBORG laboratory, Department of Radiology, Children's Hospital Los Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern California, CA, USA.,Department of Radiology, University of Southern California, CA, USA
| | - John Wood
- Division of Cardiology, Children's Hospital Los Angeles, CA, USA
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37
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Kawadler JM, Kirkham FJ, Clayden JD, Hollocks MJ, Seymour EL, Edey R, Telfer P, Robins A, Wilkey O, Barker S, Cox TC, Clark CA. White Matter Damage Relates to Oxygen Saturation in Children With Sickle Cell Anemia Without Silent Cerebral Infarcts. Stroke 2015; 46:1793-9. [DOI: 10.1161/strokeaha.115.008721] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/14/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Sickle cell anemia is associated with compromised oxygen-carrying capability of hemoglobin and a high incidence of overt and silent stroke. However, in children with no evidence of cerebral infarction, there are changes in brain morphometry relative to healthy controls, which may be related to chronic anemia and oxygen desaturation.
Methods—
A whole-brain tract-based spatial statistics analysis was carried out in 25 children with sickle cell anemia with no evidence of abnormality on T2-weighted magnetic resonance imaging (13 male, age range: 8–18 years) and 14 age- and race-matched controls (7 male, age range: 10–19 years) to determine the extent of white matter injury. The hypotheses that white matter damage is related to daytime peripheral oxygen saturation and steady-state hemoglobin were tested.
Results—
Fractional anisotropy was found to be significantly lower in patients in the subcortical white matter (corticospinal tract and cerebellum), whereas mean diffusivity and radial diffusivity were higher in patients in widespread areas. There was a significant negative relationship between radial diffusivity and oxygen saturation (
P
<0.05) in the anterior corpus callosum and a trend-level negative relationship between radial diffusivity and hemoglobin (
P
<0.1) in the midbody of the corpus callosum.
Conclusions—
These data show widespread white matter abnormalities in a sample of asymptomatic children with sickle cell anemia, and provides for the first time direct evidence of a relationship between brain microstructure and markers of disease severity (eg, peripheral oxygen saturation and steady-state hemoglobin). This study suggests that diffusion tensor imaging metrics may serve as a biomarker for future trials of reducing hypoxic exposure.
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Affiliation(s)
- Jamie M. Kawadler
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Fenella J. Kirkham
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Jonathan D. Clayden
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Matthew J. Hollocks
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Emma L. Seymour
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Rosanna Edey
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Paul Telfer
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Andrew Robins
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Olu Wilkey
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Simon Barker
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Tim C.S. Cox
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Chris A. Clark
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
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Chen R, Arkuszewski M, Krejza J, Zimmerman RA, Herskovits EH, Melhem ER. A prospective longitudinal brain morphometry study of children with sickle cell disease. AJNR Am J Neuroradiol 2014; 36:403-10. [PMID: 25234033 DOI: 10.3174/ajnr.a4101] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Age-related changes in brain morphology are crucial to understanding the neurobiology of sickle cell disease. We hypothesized that the growth trajectories for total GM volume, total WM volume, and regional GM volumes are altered in children with sickle cell disease compared with controls. MATERIALS AND METHODS We analyzed T1-weighted images of the brains of 28 children with sickle cell disease (mean baseline age, 98 months; female/male ratio, 15:13) and 28 healthy age- and sex-matched controls (mean baseline age, 99 months; female/male ratio, 16:12). The total number of MR imaging examinations was 141 (2-4 for each subject with sickle cell disease, 2-3 for each control subject). Total GM volume, total WM volume, and regional GM volumes were measured by using an automated method. We used the multilevel-model-for-change approach to model growth trajectories. RESULTS Total GM volume in subjects with sickle cell disease decreased linearly at a rate of 411 mm(3) per month. For controls, the trajectory of total GM volume was quadratic; we did not observe a significant linear decline. For subjects with sickle cell disease, we found 35 brain structures that demonstrated age-related GM volume reduction. Total WM volume in subjects with sickle cell disease increased at a rate of 452 mm(3) per month, while the trajectory of controls was quadratic. CONCLUSIONS There was a significant age-related decrease in total GM volume in children with sickle cell disease. The GM volume reduction was spatially distributed widely across the brain, primarily in the frontal, parietal, and occipital lobes. Total WM volume in subjects with sickle cell disease increased at a lower rate than for controls.
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Affiliation(s)
- R Chen
- From the Department of Diagnostic Radiology and Nuclear Medicine (R.C., J.K., E.H.H., E.R.M.), University of Maryland, Baltimore, Maryland Department of Radiology (R.C., R.A.Z.), Raymond and Ruth Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - M Arkuszewski
- Department of Neurology (M.A.), Medical University of Silesia, Katowice, Poland
| | - J Krejza
- From the Department of Diagnostic Radiology and Nuclear Medicine (R.C., J.K., E.H.H., E.R.M.), University of Maryland, Baltimore, Maryland
| | - R A Zimmerman
- Department of Radiology (R.A.Z.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Radiology (R.C., R.A.Z.), Raymond and Ruth Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - E H Herskovits
- From the Department of Diagnostic Radiology and Nuclear Medicine (R.C., J.K., E.H.H., E.R.M.), University of Maryland, Baltimore, Maryland
| | - E R Melhem
- From the Department of Diagnostic Radiology and Nuclear Medicine (R.C., J.K., E.H.H., E.R.M.), University of Maryland, Baltimore, Maryland
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39
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Social competence in children with brain disorders: a meta-analytic review. Neuropsychol Rev 2014; 24:219-35. [PMID: 24648014 DOI: 10.1007/s11065-014-9256-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
Abstract
Social competence, i.e. appropriate or effective social functioning, is an important determinant of quality of life. Social competence consists of social skills, social performance and social adjustment. The current paper reviews social skills, in particular emotion recognition performance and its relationship with social adjustment in children with brain disorders. In this review, normal development and the neuro-anatomical correlates of emotion recognition in both healthy children and adults and in various groups of children with brain disorders, will be discussed. A systematic literature search conducted on PubMed, yielded nine papers. Emotion recognition tasks were categorized on the basis of task design and emotional categories to ensure optimal comparison across studies before an explorative meta-analysis was conducted. This meta-analytic review suggests that children with brain disorders show impaired emotion recognition, with the recognition of sad and fearful expressions being most impaired. Performance did not seem to be related to derivative measures of social adjustment. Despite the limited number of studies on a variety of brain disorders and control groups, outcomes were quite consistent across analyses and corresponded largely with the existing literature on development of emotion recognition in typically developing children. More longitudinal prospective studies on emotion recognition are needed to gain insight into recovery and subsequent development of children with distinct brain disorders. This will aid development, selection and implementation of interventions for improvement of social competence and quality of life in children with a brain disorder.
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Mackin RS, Insel P, Truran D, Vichinsky EP, Neumayr LD, Armstrong FD, Gold JI, Kesler K, Brewer J, Weiner MW. Neuroimaging abnormalities in adults with sickle cell anemia: associations with cognition. Neurology 2014; 82:835-41. [PMID: 24523480 DOI: 10.1212/wnl.0000000000000188] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study was conducted to determine the relationship of frontal lobe cortical thickness and basal ganglia volumes to measures of cognition in adults with sickle cell anemia (SCA). METHODS Participants included 120 adults with SCA with no history of neurologic dysfunction and 33 healthy controls (HCs). Participants were enrolled at 12 medical center sites, and raters were blinded to diagnostic group. We hypothesized that individuals with SCA would exhibit reductions in frontal lobe cortex thickness and reduced basal ganglia and thalamus volumes compared with HCs and that these structural brain abnormalities would be associated with measures of cognitive functioning (Wechsler Adult Intelligence Scale, 3rd edition). RESULTS After adjusting for age, sex, education level, and intracranial volume, participants with SCA exhibited thinner frontal lobe cortex (t = -2.99, p = 0.003) and reduced basal ganglia and thalamus volumes compared with HCs (t = -3.95, p < 0.001). Reduced volume of the basal ganglia and thalamus was significantly associated with lower Performance IQ (model estimate = 3.75, p = 0.004) as well as lower Perceptual Organization (model estimate = 1.44, p = 0.007) and Working Memory scores (model estimate = 1.37, p = 0.015). Frontal lobe cortex thickness was not significantly associated with any cognitive measures. CONCLUSIONS Our findings suggest that basal ganglia and thalamus abnormalities may represent a particularly salient contributor to cognitive dysfunction in adults with SCA.
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Affiliation(s)
- R Scott Mackin
- From the Department of Psychiatry (R.S.M.), University of California, San Francisco; Center for Imaging of Neurodegenerative Diseases (R.S.M., P.I., D.T., J.B., M.W.W.), San Francisco Veterans Administration Medical Center, San Francisco; Hematology/Oncology Department (E.P.V., L.D.N.), Children's Hospital & Research Center Oakland; Keck School of Medicine (J.I.G.), University of Southern California; Departments of Anesthesiology and Pediatrics (J.I.G.), Children's Hospital Los Angeles, CA; Rho, Inc. (K.K.), Research Triangle Park, NC; Department of Pediatrics (F.D.A.), University of Miami Miller School of Medicine and Holtz Children's Hospital, Miami, FL; and Veterans Administration Medical Center (M.W.W.), and Departments of Radiology, Medicine, Psychiatry, and Neurology, University of California, San Francisco
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EXAMINER executive function battery and neurologic morbidity in pediatric sickle cell disease. J Int Neuropsychol Soc 2014; 20:29-40. [PMID: 24280593 DOI: 10.1017/s1355617713001239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Sickle cell disease (SCD) is blood disorder with a high risk for cerebral vascular morbidities that impact neurocognitive functioning. Specific cognitive abilities are known to be more sensitive to neurologic effects of SCD than IQ scores, yet there is little consensus about which measures to use to assess neurocognitive functioning. We evaluated the ability of the Executive Abilities: Methods and Instruments for Neurobehavioral Evaluation and Research (EXAMINER) Battery to detect neurologic effects in SCD. Thirty-two youth with SCD and sixty demographically-matched comparison youth completed the EXAMINER Battery and selected tests from the Woodcock-Johnson Tests of Cognitive Ability, 3rd edition (WJ-III). Neurologic severity was examined via clinical history for morbidities and midsagittal corpus callosum (CC) area. Results indicated cognitive performance decreased with increasing neurologic morbidity across all cognitive measures; two of four EXAMINER factors were related to CC area. The association with clinical history and midsagittal CC area appeared at least as large for the Examiner Battery scores as for the WJ-III measures. The Examiner Battery showed sensitivity to neurologic history and white matter effects in SCD; this new measure compares favorably to established measures of disease-related neurocognitive effects, but would benefit from further development.
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Venkataraman A, Adams RJ. Neurologic complications of sickle cell disease. HANDBOOK OF CLINICAL NEUROLOGY 2014; 120:1015-25. [PMID: 24365368 DOI: 10.1016/b978-0-7020-4087-0.00068-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Sickle cell disease (SCD) is a group of genetic blood disorders that vary in severity, but the most severe forms, primarily homozygous sickle cell anemia, are associated with neurologic complications. Over the last 90 years it has become established that some patients will develop severe arterial disease of the intracranial brain arteries and suffer brain infarction. Smaller infarctions and brain atrophy may also be seen and over time there appear to be negative cognitive effects in some patients, with or without abnormal brain imaging. Focal mononeuropathies and pneumococcal meningitis are also more common in these patients. Brain infarction in children can largely be prevented screening children beginning at age 2 years and instituting regular blood transfusion when the Doppler indicates high stroke risk (>200cm/sec). Iron overload and the uncertain duration of transfusion are disadvantages but overall this approach, tested in a randomized clinical trial, reduced first stroke by over 90%. Secondary stroke prevention has not been subjected to a randomized controlled trial except for one recently stopped comparison of regular transfusions compared to hydroxuyrea (results favored transfusion). The usual stroke prevention agents (such as aspirin or warfarin) have not been rigorously tested. Magnetic resonance imaging and positron emission tomography give evidence of subtle and sometimes overt brain injury due to stroke in many adults, but a preventive strategy for adults with SCD has not been developed. Bone marrow transplantation is the only cure, but some non-neurologic symptoms can be controlled in adults with hydroxuyrea.
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Affiliation(s)
- Akila Venkataraman
- Pediatric Neurology and Epilepsy Division, Lutheran Medical Center, Brooklyn, NY, USA
| | - Robert J Adams
- South Carolina Stroke Center of Economic Excellence and Medical University of South Carolina Stroke Center, Charleston, SC, USA.
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Kawadler JM, Clayden JD, Kirkham FJ, Cox TC, Saunders DE, Clark CA. Subcortical and cerebellar volumetric deficits in paediatric sickle cell anaemia. Br J Haematol 2013; 163:373-6. [PMID: 23889205 DOI: 10.1111/bjh.12496] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/26/2013] [Indexed: 11/29/2022]
Abstract
Sickle cell anaemia (SCA) is associated with silent cerebral infarction (SCI), affecting white and cortical grey matter, but there are few data on subcortical volumes. We analysed retrospective magnetic resonance imaging (MRI) data in 26 SCA patients and 20 controls, comparing mean subcortical volumes between three groups: controls, SCA with SCI (n = 13) and SCA without visible abnormality (n = 13). Specific volumetric differences were found in the hippocampus, amygdala, pallidum, caudate, putamen, thalamus, and cerebellum. This is the first study to demonstrate subcortical volume change in SCA, with the most severe volumetric deficits occurring in children with SCI seen on MRI.
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Affiliation(s)
- Jamie M Kawadler
- Imaging & Biophysics Unit, Institute of Child Health, University College London, London, UK
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Sun B, Brown RC, Hayes L, Burns TG, Huamani J, Bearden DJ, Jones RA. White matter damage in asymptomatic patients with sickle cell anemia: screening with diffusion tensor imaging. AJNR Am J Neuroradiol 2012; 33:2043-9. [PMID: 22595904 DOI: 10.3174/ajnr.a3135] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Ischemic injury to the brain is a common complication of SCA. To better understand the neurologic impact of SCA, TBSS were applied to DTI data to investigate white matter injuries in pediatric patients with SCA. MATERIALS AND METHODS TBSS comparisons of a range of anisotropy and diffusion measures were carried out between age- and background-matched population groups: patients with SCA with no visible lesions, patients with SCA with mild gliosis, and normal controls. RESULTS TBSS analysis revealed that both SCA populations exhibited reduced anisotropy and increased diffusivity compared with normal controls in multiple brain regions, including the corpus callosum and centrum semiovale. Furthermore, the results suggest that the severity of SCA is positively correlated with the white matter changes in the corpus callosum. CONCLUSIONS The study demonstrates that TBSS is a viable technique in detecting subtle white matter damage in patients with SCA whose conventional anatomic MR imaging scans show no, or minimal, abnormalities and has the potential to evaluate the neurologic impact of the treatment of SCA.
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Affiliation(s)
- B Sun
- Departments of Radiology, Children’s Healthcare of Atlanta, Atlanta, GA 30342, USA
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DeBaun MR, Armstrong FD, McKinstry RC, Ware RE, Vichinsky E, Kirkham FJ. Silent cerebral infarcts: a review on a prevalent and progressive cause of neurologic injury in sickle cell anemia. Blood 2012; 119:4587-96. [PMID: 22354000 PMCID: PMC3367871 DOI: 10.1182/blood-2011-02-272682] [Citation(s) in RCA: 218] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 01/05/2012] [Indexed: 11/20/2022] Open
Abstract
Silent cerebral infarct (SCI) is the most common form of neurologic disease in children with sickle cell anemia (SCA). SCI is defined as abnormal magnetic resonance imaging (MRI) of the brain in the setting of a normal neurologic examination without a history or physical findings associated with an overt stroke. SCI occurs in 27% of this population before their sixth, and 37% by their 14th birthdays. In adults with SCA, the clinical history of SCI is poorly defined, although recent evidence suggests that they too may have ongoing risk of progressive injury. Risk factors for SCI include male sex, lower baseline hemoglobin concentration, higher baseline systolic blood pressure, and previous seizures. Specific morbidity associated with SCI includes a decrement in general intellectual abilities, poor academic achievement, progression to overt stroke, and progressive SCI. In addition, children with previous stroke continue to have both overt strokes and new SCI despite receiving regular blood transfusion therapy for secondary stroke prevention. Studies that only include overt stroke as a measure of CNS injury significantly underestimate the total cerebral injury burden in this population. In this review, we describe the epidemiology, natural history, morbidity, medical management, and potential therapeutic options for SCI in SCA.
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Affiliation(s)
- Michael R DeBaun
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
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Northam GB, Liégeois F, Chong WK, Wyatt JS, Baldeweg T. Total brain white matter is a major determinant of IQ in adolescents born preterm. Ann Neurol 2011; 69:702-11. [PMID: 21391229 DOI: 10.1002/ana.22263] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 09/07/2010] [Accepted: 09/09/2010] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In preterm infants, white matter (WM) abnormalities detected on magnetic resonance imaging (MRI) at term-age are associated with early developmental delay. We set out to study this association in adolescents born pre-term, by examining intellectual outcome in relation to markers of brain injury, focusing on the effects of WM reduction. METHODS Seventy-nine participants were recruited and assessed at a mean age of 16 years: 49 adolescents born preterm (<32 weeks' gestation) with a wide spectrum of brain injuries (including 22 with no identifiable brain injury at birth) and 30 term-born controls. Data collected included: brain MRI scans, full-scale intelligence quotient (IQ) scores, educational attainments, and behavioral scores. Measures of WM reduction included total volume, cross-sectional area of the corpus callosum (CC), and ventricular dilatation. Cerebellar volumes and neuroradiological ratings were also included. RESULTS WM volume and IQ were reduced in the preterm groups (both with and without brain injury). Total WM volume and CC area jointly explained 70% of IQ variance in the adolescents born preterm, irrespective of the presence or severity of brain abnormalities detected at birth or on follow-up MRI. This relationship was not seen in controls. Importantly, correlations were also found with real-world measures of academic achievement and behavioral difficulties. INTERPRETATION Preterm birth has a long-term effect on cognition, behavior, and future academic success primarily as a consequence of global brain WM reduction. This emphasizes the need for early therapeutic efforts to prevent WM injury and promote or optimize its development in preterm neonates.
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Affiliation(s)
- Gemma B Northam
- Institute of Child Health, University College London, London, United Kingdom
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Abstract
We investigated the association of increased cerebral blood flow velocity with specific language abilities in children with sickle cell disease (SCD). Thirty-nine children ages 5 to 8 years old with high-risk genotypes of SCD underwent cognitive testing, which included tests of language skills, visual motor skills, and attention/working memory as part of a routine hematology health-maintenance visit. Transcranial Doppler (TCD) velocities were obtained from review of medical records, with the velocities that were in closest temporal proximity to the cognitive assessment used in the analysis. TCD velocities predicted scores on tests of syntactical skills, even when controlling for anemia severity. Semantic and phonological ability and other cognitive skills were not strongly related to TCD velocities. Elevated blood flow velocities in children with high-risk SCD may contribute to a specific language impairment or to a broader dysfunction of short-term and/or working memory. This study underscores the need for clinicians to monitor language skills of children with SCD who have elevated TCD velocities, as these cognitive abilities might be particularly sensitive to cerebrovascular disruption related to their disease.
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Abstract
PURPOSE Stroke and subclinical "silent infarcts" are major causes of morbidity in children with Sickle Cell Disease (SCD). Ischemic strokes are more common in younger children while hemorrhagic strokes are more frequent in adults. The goal of neuroimaging in acute stroke is to document whether the stroke is ischemic or hemorrhagic, to assess the extent of parenchymal abnormalities and to determine the presence of other cerebrovascular lesions. Computed Tomography (CT) is the primary modality for the assessment of acute stroke patients because of its 24/7 availability and ability to exclude hemorrhagic causes. Magnetic resonance imaging (MRI) and MR angiography (MRA) are recommended to determine precisely extent of infarction and detect cerebrovascular abnormalities. The goal of neuroimaging in patients with hemorrhagic stroke is to identify an arteriovenous malformation or aneurysm(s) amenable to surgery or catheter intervention.The risk of first stroke is very high in asymptomatic children with intracranial arterial mean velocities over 200 cm/s on transcranial Doppler (TCD) examination. The risk can be substantially reduced if chronic blood transfusions are timely implemented. Large cerebral vessel disease detected by TCD can be confirmed or excluded by MRI/MRA. Those with evidence of parenchymal and/or cerebrovascular lesions should be followed by preventive therapy. In patients with neurologic symptoms and negative MRI/MRA findings Positron Emission Tomography or single photon emission CT is recommended. There are no specific neuroimaging findings that suggest that blood transfusions can be safely halted in children with SCD.
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Abstract
OBJECTIVE To verify the hypothesis that volume of regional gray matter accounts substantially for variability in intelligence quotient (IQ) score among children with sickle cell disease, who have no magnetic resonance visible infarcts. METHODS We studied 31 children with sickle cell disease, homozygous for hemoglobin S, with no history of stroke, no magnetic resonance signal-intensity abnormality, and transcranial Doppler velocities <170 cm/sec, with a T1-weighted magnetic resonance sequence and the Kaufman Brief Intelligence Test. On the basis of Kaufman Brief Intelligence Test, we classified these children into 2 groups: high and low IQ based on a median split. We then used an automated and novel Bayesian voxel-based morphometry technique, called Graphical-Model-Based Multivariate Analysis (GAMMA), to assess the probabilistic association between IQ score and regional gray matter volume. RESULTS GAMMA found 1 region linking low IQ with smaller cortical gray matter volume. In comparison with the children in the high-IQ group, children in the low-IQ group had smaller regional gray matter volume in both frontal lobes, both temporal lobes, and both parietal lobes. CONCLUSIONS In children with sickle cell disease, we found a linear association between IQ and regional gray matter volume. This finding suggests that some variance in intellectual ability in children with sickle cell disease is accounted for by regional variability of gray matter volume, which is independent of neuroradiological evidence of infarct.
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Schatz J, Puffer ES, Sanchez C, Stancil M, Roberts CW. Language Processing Deficits in Sickle Cell Disease in Young School-Age Children. Dev Neuropsychol 2009; 34:122-36. [DOI: 10.1080/87565640802499191] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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