Adams et al used transcranial ultrasonography to evaluate patients with sickle cell disease. This can identify a patient who may be at increased risk for stroke. The authors are from the Medical College of Georgia.


Patient selection: pediatric patient with sickle cell disease


Method: transcranial ultrasonography to measure maximum blood flow velocity in the left and/or right middle cerebral artery


An increased velocity is associated with:

(1) increasing levels of arterial stenosis

(2) anemia


Cutoff for increased risk: >= 170 cm/s


Additional parameters:

(1) trend in the maximum velocity, with increasing velocities associated with increasing risk

(2) history of previous stroke

(3) velocity > 200 cm/s

(4) neurological signs and symptoms suggestive of stroke


A patient at increased risk may be a candidate for:

(1) long-term transfusion therapy and/or bone marrow transplantation.

(2) angiography to define the severity and extent of vascular stenosis



• The cutoff of >= 170 cm/s was associated with a sensitivity of 86% and specificity of 91%


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