Stroke risk assessment in children with sickle cell disease using transcranial Doppler ultrasound in Cameroon

Abstract

Introduction: Stroke is a severe complication of sickle cell disease, often resulting from cerebral vasculopathy. Transcranial Doppler Ultrasound is a validated tool for stroke risk prediction in sickle cell disease, enabling timely preventive interventions. This study assessed cerebral vasculopathy in children with sickle cell disease using transcranial Doppler in three hospitals in Cameroon. Methods: a cross-sectional study was conducted from January to April 2024 in Buea, Limbe, and Laquintinie Hospitals. Children aged 2-16 years with confirmed sickle cell disease were evaluated. Data on demographics, clinical history, immunization status, hematological parameters, and cerebral blood flow velocities (time-averaged mean maximum velocity and peak systolic velocity in the middle cerebral and distal internal carotid arteries) were collected. Stroke risk was classified per the stroke prevention trial for sickle cell anemia (STOP) trial criteria. Statistical analysis included descriptive, bivariate, and multivariate methods (SPSS v23.0), with significance set at p<0.05. Results: among 110 participants (mean age 8.35 ± 3.74 years), 79.1% had normal arterial velocities, 12.7% intermediate, and 8.2% high velocities, indicating elevated stroke risk. Acute chest infections could be significantly associated with high velocities, while prophylactic vaccination (meningococcal and pneumococcal) could be protective. Conclusion: approximately 8.2% of children with sickle cell disease showed high cerebral artery velocities, suggesting high stroke risk. Acute chest infections may exacerbate this risk, whereas vaccination could appear protective. Transcranial Doppler is a valuable tool for early stroke risk stratification in pediatric sickle cell disease populations in resource-limited settings.