Sickle-cell disease stroke throughout life: a retrospective study in an adult referral center

Am J Hematol. 2014 Mar;89(3):267-72. doi: 10.1002/ajh.23625.


Strokes are one of the most severe complications of sickle-cell disease. Most studies have been restricted to children with sickle-cell disease. To better understand the characteristics and follow-up of strokes occurring from childhood to adulthood, we undertook a retrospective cohort study of 69 stroke patients among the 2,875 patients consulting at the French Adult Sickle-Cell Disease Referral Center. Between 1970 and 2008, they had experienced 104 strokes: 80 ischemic, 22 hemorrhagic, and 2 intracranial sinus thromboses. Coma and/or fatal outcomes underscored the severity of strokes in sickle-cell disease patients.Hemorrhagic strokes occurred mostly in adults and carried a higher risk of death than ischemic stroke. The mechanisms underlying sickle-cell disease associated strokes were reevaluated and etiologies were determined for first stroke and recurrences, in childhood and adulthood. Sickle-cell disease vasculopathy concerned only SS patients and remains their most frequent stroke etiology. Cardioembolism, vaso-occlusive crisis and triggering factors were other etiologies identified in adults. Recurrences occurred in 19 SS patients only after a first ischemic stroke. SC patients' strokes occurred in adulthood and were associated with cardiovascular risk factors. Our findings provide novel information about cerebrovascular pathologies throughout the lives of sickle-cell disease patients and suggest the need for different diagnostic and therapeutic management approaches in those different settings.

MeSH terms

  • Adult
  • Age of Onset
  • Aged
  • Anemia, Sickle Cell / complications*
  • Brain Ischemia / epidemiology
  • Brain Ischemia / etiology
  • Cerebral Hemorrhage / epidemiology
  • Cerebral Hemorrhage / etiology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Referral and Consultation
  • Retrospective Studies
  • Risk Factors
  • Stroke / classification
  • Stroke / epidemiology
  • Stroke / etiology*
  • Young Adult