DeBaun M R, Schatz J, Siegel M J, Koby M, Craft S, Resar L, Chu J Y, Launius G, Dadash-Zadeh M, Lee R B, Noetzel M
Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA.
Neurology. 1998 Jun;50(6):1678-82. doi: 10.1212/wnl.50.6.1678.
In children with sickle cell disease (SCD), silent cerebral infarcts are the most frequent cause of neurologic injury. We determined the sensitivity and specificity of selective neurocognitive measures when separating children with silent cerebral infarcts and SCD from sibling controls. Additionally, we tested the validity of the same cognitive measures to identify patients with overt strokes.
We examined performance on a neuropsychologic battery containing measures of attention/executive, spatial, language, memory, and motor functioning for seven children with SCD and silent cerebral infarct, 21 children with SCD and overt stroke, and 17 normal siblings. Diagnosis of cerebral infarct was based on results of MRI.
Measures from the attention and executive domains were the most useful for identifying children with silent cerebral infarct. The Test of Variables of Attention was the most robust measure and yielded a sensitivity rate of 86% and a specificity rate of 81%. This measure also showed a sensitivity rate of 95% in identifying overt stroke.
Brief cognitive screening measures, if properly constructed, may be an effective means of identifying children with silent cerebral infarct. Future prospective studies should be pursued to assess the utility of cognitive screening for silent cerebral infarcts in SCD.
在镰状细胞病（SCD）患儿中，无症状脑梗死是神经损伤最常见的原因。我们确定了在区分有无无症状脑梗死的SCD患儿与同胞对照时，选择性神经认知测量方法的敏感性和特异性。此外，我们还测试了相同认知测量方法用于识别有明显中风患者的有效性。
我们对7例患有SCD和无症状脑梗死的患儿、21例患有SCD和明显中风的患儿以及17名正常同胞进行了一组神经心理学测试，这些测试包括注意力/执行功能、空间、语言、记忆和运动功能的测量。脑梗死的诊断基于MRI结果。
注意力和执行领域的测量方法对于识别有无无症状脑梗死的患儿最有用。注意力变量测试是最可靠的测量方法，敏感性率为86%，特异性率为81%。该测量方法在识别明显中风时的敏感性率也为95%。
如果构建得当，简短的认知筛查方法可能是识别有无无症状脑梗死患儿的有效手段。未来应进行前瞻性研究，以评估认知筛查对SCD中无症状脑梗死的效用。
