Transcranial doppler ultrasound versus neurologic examination in detection of cerebral infarction in children with sickle cell disease

ABSTRACT

Cerebral infarctions are a major source of disability in children with sickle cell disease [SCD], leading to serious impairment in cognitive and motor functions. The aim of the present work is to assess the value of transcranial Doppler ultrasonography [TCD] of the middle cerebral artery [MCA] and neurologic examination in detection of cerebral infarction in children with SCD. The present work included 28 children [10 boys, and 18 girls] aged 5 to 13 years, underwent full neurologic examination, non-contrast CT of the brain, and TCD. TCD was evaluated for maximum flow velocity in the right and left MCAs. The sensitivity and specificity of neurologic examination for identification of patients with infarction were 55.6% and 89.5% respectively. Depending on the alteration in the maximum flow velocity of the MCA either <100 cm/sec or > 200 cm/sec, the TCD allowed detection of 7 out of 9 patients with documented CT evidence of cerebral infarction with only one false positive result [77.9% sensitivity and 94.4% specificity]. The combination of neurologic examination and TCD produced 88.9% sensitivity and specificity, for detection of cerebral infarction. We conclude that TCD of the MCA can be used as a screening method for identifying children with SCD at risk for developing strokes. Single vessel examination namely MCA makes the examination more easy, of shorter duration, and more suitable for children with no need for special preparation or sedation. The combination of neurologic examination and TCD is promising as a sensitive screening test in this patient population