Hemodynamic etiology of stroke risk in children with sickle cell anemia
Przemyslaw Kosinski 1 , Paula Croal 2 , Jackie Leung 2 , and Andrea Kassner 2,3
Institute of Medical Science, The University
of Toronto, Toronto, Ontario, Canada,
& Experimental Medicine, The Hospital for Sick Children,
Imaging, The University of Toronto, Toronto, Ontario,
The stroke etiology in children with sickle cell anemia
(SCA) is thought to be a result large-vessel stenosis.
However, 32% of post-stroke children present without a
history of stenosis. An alternative etiology is the
hemodynamic insufficiency model which proposes that
severe anemia exhausts vasodilatory capacity thus
increasing the susceptibility for ischemic injury. We
measured cerebrovascular reactivity (CVR) using BOLD MRI
in synchrony with a hypercapnic stimulus to quantify
vasodilatory capacity. Our results show that CVR is
significantly associated with the degree of anemia
(Hematocrit) in the gray matter (r=0.84,p<0.001) and
white matter (r=0.81,p<0.001). These results favour the
hemodynamic insufficiency model.
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