rare cause of children's vascular cerebral ischemic strije: sickle cell disease

ABSTRACT

Ischemic cerebral infarctions are uncommun in childhood. Aetiologies are numerous. The etiologic diagnosis is difficult and this case further proves it. Amina, 9 years old, is admitted in Pediatrics 2 of Children's Hospital in Casablanca, for polyarthralgia evolving for one year, with right hemiplegia. Right hemiconvulsions had preceded the neurologic motor deficency. Cerebral scanner shows ischemic lesions confirming the ischemic stroke. Etiologic screening allowed elimination of systemic diseases, high blood pressure, congenital heart diseases and rythm disorders. Haemoglobin electrophoresis confirmed the homozygote sickle cell disease showing a high 84% rate of S haemoglobinemia. Split in four groups cardiac, vascular, hematologic and metabolic diseases. But a large number stays idiopathic. The ischemic stroke is confirmed at once by cerebral scanner. Then in case of no evident aetiology, the first step involves monitoring of blood pressure and cardiac check-up, followed by hemoglobin electrophoresis. Appropriate questionning and well examination after stroke in children are very important. In our case, semiologic features of pain which were acute, none inflammatory and none mechanical, along with mongoloid facies, were suffisant to lead to the real diagnosis. The particularity of our patient is that she was not known for suffering from sickle cell disease, and it was the stroke that revealed it. It's difficult to suggest a plan for diagnosis evaluation for children who undergo an acute cerebral ischemic stroke, but a thorough questionning and examination can be helpful to make the etiologic diagnosis. However a first strategie is proposed