Stroke among Children with Sickle Cell Anemia in Mulago Hospital, Uganda

Background: Sickle Cell Anemia (SCA) is a leading cause of child morbidity and mortality affecting 4% of all newborns in Uganda. Stroke is a serious complication of SCA in childhood and 10% of patients with SCA will have had a stroke by the age of 20 years. Hitherto there has been limited information on SCA stroke in Uganda. Objective: To describe the clinical presentation of children with SCA stroke; and hematological indices and interventions in those with a stroke. Method: We studied 46 SCA children aged 2-18 years attending the sickle cell services of Mulago Hospital in Uganda from February to June 2011. Numerical data was summarized into mean +/- standard deviation for normally distributed variables and ranges +/- inter-quartile range for skewed data. Categorical data was summarized into percentages. Results: Forty six SCA children with stroke are described in this case series. The median age at first stroke was 4 years [Inter-quartile range (IQR) 2-6]. Symptoms of children with SCA stroke included behavior changes, headache and seizures. Findings on physical examination included hemiplegia, aphasia, and limb ataxia. Four of the 46 children with SCA stroke had a sickle cell hemoglobin (HbS) <30%. Ninety five percent (44/46) of the children had received a blood transfusion. Conclusion: Children with stroke in sickle cell anemia presented with a range of neurological symptoms and signs. Further research is needed to determine the risk factors for stroke in our population.