Pediatrics Medical News about children; sickle cell anemia; post-bulb ICA stenosis; submandibular TCD

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Submandibular TCD approach detects post-bulb ICA stenosis in children with sickle cell anemia
Neurology, 06/25/09

Gorman MJ et al. - Using the extended submandibular approach to evaluate these portions of the ICA, the authors identified stenotic lesions in 4 patients with Hb SS disease out of a population of 131 children with Hb SS. Three of the 4 patients had no history of overt stroke or stroke-like symptoms. Neuroimaging confirmed the stenotic lesions, and also revealed watershed infarction as well as discrete areas of silent infarction. All 4 children had neuropsychological impairment. The submandibular approach, when added to a standard transcranial Doppler examination, may increase the sensitivity of this technique to identify important potential sources of cerebral infarction.

Exclusive Author Commentary
Mark J. Gorman, 07/02/09

The submandibular approach may extend the usefulness of TCD monitoring for cerebrovascular compromise in children with sickle cell disease. Based on high flow velocities, but without stenotic lesions noted on MRA, there are indications that physiological changes in the circulation may also be of importance in this unique and high-risk population. The data here add to the understanding that silent infarction and watershed infarction may be related to the neuropsychological impairment that is noted in many of these patients.

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