Evidence-Based Emergency Neuroimaging in Children and Adults with Sickle Cell Disease and Symptoms of Stroke

Stroke is a major cause of morbidity in children with sickle cell disease. There is a broad spectrum of acute presentations of both ischemic and hemorrhagic strokes. The optimal medical management of patients with acute ischemic stroke is not yet determined based on randomized clinical trials. Non-contrast computed tomography (CT) remains the initial test of choice for emergency brain assessment of patients with acute stroke. Magnetic resonance imaging (MRI) may be as accurate as CT for the detection of acute hemorrhage in patients presenting with acute stroke symptoms and is more accurate than CT for the detection of ischemic stroke and chronic intracerebral hemorrhage. CT angiography, CT perfusion, MR angiography, and MR venography can be added to emergency CT to detect large arterial vasculopathy, perfusion defects, and cerebral venous thrombosis; however, there is no sufficient evidence to justify their emergency use.