Clinical silent cerebral infarct (SCI) in patients with thalassemia diseases assessed by Magnetic Resonance Imaging (MRI)

Abstract

Background: Silent cerebral infarct (SCI) could be detected on magnetic resonance imaging. It seems to be associated with the risk of stroke. Ischemic stroke has been reported in sickle cell anemia. Sickle red cell in hypoxic state associated with hypercoagulopathy is the risk factor of blood vessel occlusion leading toischemic stroke. Hypercoagulable state has been documented in patients with β thalassemia/Hb E disease, which their red cells are abnormal in deformity. Objective: Explore SCI in patients with β thalassemia/Hb E disease and provide a guideline for prevention of stroke. Material and Method: Sixty-seven patients (29 males and 28 females, age 10-59 yrs, with a mean age of 31) with β-thal/Hb E disease who were in the steady state without any neurological sign and symptom and no other associated stroke related disease such as DM, HT were included for MRI. scanning. The cerebral MRI protocals were axial Flair, T2 Gre and 3DTOFMRA (3-dimension time of flight magnetic resonance angiography) of the brain. Results: 67 patients (29 males and 28 females) with β-thal/Hb E disease who were in the steady state without any neurological sign and symptom and no other associate stroke related disease such as DM, HT were included for MRI scanning. The ages of the patients were 10 to 59 years with a mean of 31 years. The abnormalities of the brain were found in 16 of 67 (24%). Most of the lesions were lacunar infarcts with varying amounts in the deep cerebral white matter. One cortical and subcortical infarct was observed with irregularity and stenosis of the intracranial vessels noted by MRA. All cases showed increased vascularity compared to the normal control subject. Conclusion: This preliminary prevalence of 24% of SCI in this genotype of thalassemia was higher than found in sickle cell disease (11%). It may be associated with coagulopathy and deformity of the red cell. Further study is needed.