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Transcranial Doppler Ultrasonography in Sickle Cell Disease: A Study in Omani Patients

Gujjar, Arunodaya R. MBBS, DM; Zacharia, Mathew MD; Al-Kindi, Salam FRCP (I); William, Ranjan MD; Al Lamki, Zakiya FRCP; Wali, Yasser MRCP; Bashir, Wafa FRCP; Jain, Rajeev MD; Al-Asmi, Abdullah FRCP (C); Pathare, Anil MD

Journal of Pediatric Hematology/Oncology: January 2013 - Volume 35 - Issue 1 - p 18–23
doi: 10.1097/MPH.0b013e31827f0add
Original Articles

Changes on Transcranial Doppler (TCD) ultrasonography have been proposed as significant predictors of cerebrovascular complications in sickle cell disease (SCD). However, consensus with regards to the TCD criteria to recognize abnormalities in cerebral vasculature is lacking. We studied the TCD characteristics of cerebral arteries among Omani patients with SCD and correlated them with cerebrovascular events. TCD was performed through the temporal and suboccipital windows using a 2 MHz probe (DWL). Thirty-three of 59 patients (56%) with SCD had neurological symptoms including stroke—12 (20%) and epilepsy—7. Fifteen patients (25%) had significant TCD abnormalities including: markedly increased velocities—11 (3 with stroke); turbulent flow—2; and reversal of flow—2. No patient had a time averaged maximum mean velocity of >200 cm/s in anterior circulation. On applying a modified definition of “abnormal TCD” to anterior and posterior circulation studies, increased TCD velocities in posterior circulation correlated with history of stroke (P<0.05). TCD velocities in the 18 adult patients ( older than 15 y) were significantly lower than in children. Logistic regression analysis revealed abnormal TCD in the left posterior cerebral artery to be an independent predictor of stroke in this cohort (P=0.035).

Departments of *Medicine (Neurology)

Child Health

Haematology

§Radiology & Molecular Imaging, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman

Supported by Dean’s Fund, College of Medicine, Sultan Qaboos University, Muscat, Oman.

The authors declare no conflict of interest.

Reprints: Arunodaya R. Gujjar, MBBS, DM, Department of Medicine (Neurology), College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box: 35, PC 123, Muscat, Oman (e-mail: grarunoday@hotmail.com).

Received November 26, 2011

Accepted September 20, 2012

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