Inusa Baba, Casale Maddalena, Booth Caroline, Lucas Sebastian
Department of Paediatrics, Evelina Children's Hospital, London, UK.
Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Seconda Università di Napoli, Naples, Italy.
BMJ Case Rep. 2014 Oct 21;2014:bcr2014205464. doi: 10.1136/bcr-2014-205464.
Stroke in sickle cell anaemia (SCA) is either infarctive or haemorrhagic in nature. In childhood, over 75% of strokes in SCA are infarctive. We present an adolescent with SCA who developed hypertension at the age of 13, and was treated with lisinopril. Sixteen months later she was found in cardiorespiratory arrest and died on arrival in hospital. The last transcranial Doppler scan performed 6 months before her death and a brain MRI were reported normal. The autopsy discovered massive subarachnoid haemorrhage in association with vascular damage in the circle of Willis arteries. The case highlights a cause of haemorrhagic stroke, the first reported association between hypertension, SCA and a histopathologically proven cerebral vasculopathy. The difficulties in the management of haemorrhagic stroke and the poor outcome in SCA are discussed.
镰状细胞贫血（SCA）所致的中风本质上要么是梗死性的，要么是出血性的。在儿童期，SCA中超过75%的中风是梗死性的。我们报告一名患有SCA的青少年，其在13岁时患高血压，接受赖诺普利治疗。16个月后，她被发现心跳呼吸骤停，入院时死亡。在她去世前6个月进行的最后一次经颅多普勒扫描和脑部MRI报告均正常。尸检发现大量蛛网膜下腔出血，并伴有 Willis 动脉环血管损伤。该病例突出了出血性中风的一个病因，首次报道了高血压、SCA与经组织病理学证实的脑血管病变之间的关联。文中讨论了出血性中风管理中的困难以及SCA的不良预后。
