Primary hemorrhagic stroke in children with sickle cell disease is associated with recent transfusion and use of corticosteroids.


Journal Article

OBJECTIVES: Primary hemorrhagic stroke is an uncommon complication of sickle cell disease, with reported mortality rates of 24% to 65%. Most reported cases are in adults; little is known about its occurrence in children. Proposed risk factors include previous ischemic stroke, aneurysms, low steady-state hemoglobin, high steady-state leukocyte count, acute chest syndrome, and hypertransfusion. We performed a retrospective case-control study to evaluate risk and prognostic factors for primary hemorrhagic stroke among children with sickle cell disease. PATIENTS AND METHODS: Case subjects (sickle cell disease and primary hemorrhagic stroke) and control subjects (sickle cell disease and ischemic stroke) were identified at 2 children's hospitals from January 1979 to December 2004 by reviewing divisional records and the discharge databases. RESULTS: We identified 15 case subjects (mean age: 10.4 +/- 1.3 years) and 29 control subjects (mean age: 5.2 +/- 0.4 years). An increased risk of hemorrhagic stroke was associated with a history of hypertension and recent (in the last 14 days) transfusion, treatment with corticosteroids, and possibly nonsteroidal antiinflammatory drugs. Average blood pressures at well visits (adjusted for age and gender) were similar between the 2 groups, suggesting that hypertension was intermittent. CONCLUSIONS: In this group of children with sickle cell disease, hemorrhagic stroke was associated with a history of hypertension or antecedent events including transfusion or treatment with corticosteroids. Improved understanding of risk and prognostic factors, especially those that are modifiable, may help prevent this devastating complication in children with sickle cell disease.

Full Text

Duke Authors

Cited Authors

  • Strouse, JJ; Hulbert, ML; DeBaun, MR; Jordan, LC; Casella, JF

Published Date

  • November 2006

Published In

Volume / Issue

  • 118 / 5

Start / End Page

  • 1916 - 1924

PubMed ID

  • 17079562

Pubmed Central ID

  • 17079562

Electronic International Standard Serial Number (EISSN)

  • 1098-4275

Digital Object Identifier (DOI)

  • 10.1542/peds.2006-1241


  • eng

Conference Location

  • United States