Neurocognitive Assessment and detection of Stroke in Patients Diagnosed with Sickle Cell Disease: Neuropsychological Functioning and Magnetic Resonance Imaging (MRI)

Reviewer: William Levin, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: December 13, 2001

Presenter: E. Vichinsky
Presenter's Affiliation: Children's Hospital, Oakland, California
Type of Session: Scientific

Background

Children who have sickle cell disease(SCD) are at risk for the development stroke or silent infarct, often resulting in cognitive impairment.

It has been estimated that approximately 25% of all children with SCD will have a stroke or silent infarct.

The aim of the current study is to assess the neuropsychological functioning of children with SCD and evaluate them radiographically with MRI.

Materials and Methods

70 children with SCD were evaluated, 29 females and 41 males

Median age was 13 years

Testing included Wechsler Intelligence Test for Children, as well as tests for spatial reasoning, and manual dexterity.

Results

24% (n=17) experienced a stroke, 16% (n=11) had silent infarcts (normal exam with a positive MRI), 60% (n=42) had no stroke.

The most common sites of infarct were frontal lobe (42%) and parietal lobe (29%).

Children without evidence of stroke (MRI or clinically) performed in the average range of normal on all tests.

Those children with evidence of silent infarct had below average scores (compared to the no-stroke group) on the IQ verbal and performance scales, particularly in the areas of math and numerical conceptualization.

Children with evidence of stroke had significantly lower cognitive scores and achievement scores compared to the no-stroke group.

Author's Conclusions
There is a need to further investigate neurocognitive functioning in children SCD. Recognition of their specific needs will allow for the development of comprehensive treatment plans appropriately suited for each child.

Clinical/Scientific Implications
This article highlights the importance of identifying neurocognitive deficits in a population of children that might otherwise be simply classified as underachievers. With the understanding of these issues parents, educators, and mental health professionals will be better able to serve these patents.

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