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Pediatr Neurol. 2009 Aug;41(2):124-6. doi: 10.1016/j.pediatrneurol.2009.02.011.

Stroke in sickle cell anemia: alternative etiologies.

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Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9063, USA.


Stroke is common in children with sickle cell anemia, but is rarely attributed to the traditional causes of stroke identified in other children. An 11-year-old girl with sickle cell anemia presented with severe headache and was found to have recurrent bilateral multifocal strokes in a cardioembolic pattern. Evaluation revealed the presence of a patent foramen ovale, antiphospholipid antibodies, and elevations in factor VIII and lipoprotein(a). Sickle cell anemia is itself a hypercoagulable state with potential for increased right heart pressures, both of which predispose to paradoxical embolization via right-to-left intracardiac shunting of emboli, thus causing stroke. The present case suggests that the more traditional etiologies for pediatric stroke may also cause stroke in children with sickle cell anemia.

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