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Research ArticleOriginal Article
Open Access

Hematologic risk factors for stroke in Saudi children

Mustafa A. Salih, AbdelGalil M. Abdel-Gader, Ahmed A. Al-Jarallah, Amal Y. Kentab, Ibrahim A. Alorainy, Hamdy H. Hassan, Hassan M. Bahakim, Khadija M. Kurbaan, Jihad N. Zahraa, Waleed R. Murshid, Mohsen A. El-Hazmi and Waleed A. Khoja
Saudi Medical Journal March 2006, 27 (3 Supplement) S21-S34;
Mustafa A. Salih
Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, PO Box 2925, Riyadh 11461, Kingdom of Saudi Arabia. Fax. +966 (1) 4679463. E-mail: [email protected]
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  • For correspondence: [email protected]
AbdelGalil M. Abdel-Gader
Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Ahmed A. Al-Jarallah
Division of Pediatric Neurology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Amal Y. Kentab
Division of Pediatric Neurology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Ibrahim A. Alorainy
Department of Radiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Hamdy H. Hassan
Department of Radiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Hassan M. Bahakim
Division of Hematology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Khadija M. Kurbaan
Division of Hematology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Jihad N. Zahraa
Pediatric Intensive Care Unit, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Waleed R. Murshid
Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Mohsen A. El-Hazmi
Department of Surgery, Department of Medical Biochemistry, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Waleed A. Khoja
Division of Neurology, Department of Neurosciences, Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia.
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Abstract

OBJECTIVE: To explore the hematologic risk factors for stroke in a cohort of Saudi children.

METHODS: We evaluated children at the Division of Pediatric Neurology at King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, during the periods July 1992 to February 2001 (retrospective study) and February 2001 to March 2003 (prospective study). Investigations for suspected cases included neuroimaging, transcranial Doppler (TCD) for cases of sickle cell disease (SCD), and Duplex scan. Hemostatic assays included coagulation screening tests, tests of thrombin generation and fibrinolysis, coagulation inhibitors, and activated protein C resistance.

RESULTS: During the study period, 104 Saudi children (aged one month to 12 years) with stroke were seen. The mean age of the cohort was 27.1 months (SD = 39.3 months) and median was 6 months. Ischemic strokes accounted for the majority of cases (76%). A major risk factor was identified in 93 of 104 cases of stroke (89.4%). Hematologic disorders were the most common (46.2%), followed by prothrombic disorders (31.7%); microcytic hypochromic anemia (26%); sickle cell disease (SCD), or SCBetao-thalassemia, (11.5%), and factor IX deficiency (2.9%). Raised anticardiolipin antibodies (13/49, 26.5%) was the most frequent abnormality. Deficiencies of the natural anticoagulants (protein S, protein C and antithrombin III) were as follows: protein S (15/70, 21.4%); protein C (15/70, 21.4%) and combined deficiency of 2 or more inhibitors (9/70, 12.9%). Activated protein C resistance has not been detected. Contrary to the findings of previous studies from Saudi Arabia, SCD is a common risk factor and is severe, as it resulted in multiple strokes. Moyamoya syndrome was diagnosed in 2 patients with SCD, one of whom had revascularization surgery (encephaloduroarterio-synangiosis). Assessment of children with SCD at risk of stroke was helped by the introduction of TCD followed by neuroimaging, using MRI and magnetic resonance angiography.

CONCLUSION: The study strongly highlights the importance of prothrombotic disorders and the severe phenotype of SCD as risk factors for stroke in Saudi children.

  • Copyright: © Saudi Medical Journal

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Saudi Medical Journal: 27 (3 Supplement)
Saudi Medical Journal
Vol. 27, Issue 3 Supplement
1 Mar 2006
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Hematologic risk factors for stroke in Saudi children
Mustafa A. Salih, AbdelGalil M. Abdel-Gader, Ahmed A. Al-Jarallah, Amal Y. Kentab, Ibrahim A. Alorainy, Hamdy H. Hassan, Hassan M. Bahakim, Khadija M. Kurbaan, Jihad N. Zahraa, Waleed R. Murshid, Mohsen A. El-Hazmi, Waleed A. Khoja
Saudi Medical Journal Mar 2006, 27 (3 Supplement) S21-S34;

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Hematologic risk factors for stroke in Saudi children
Mustafa A. Salih, AbdelGalil M. Abdel-Gader, Ahmed A. Al-Jarallah, Amal Y. Kentab, Ibrahim A. Alorainy, Hamdy H. Hassan, Hassan M. Bahakim, Khadija M. Kurbaan, Jihad N. Zahraa, Waleed R. Murshid, Mohsen A. El-Hazmi, Waleed A. Khoja
Saudi Medical Journal Mar 2006, 27 (3 Supplement) S21-S34;
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© 2023 Saudi Medical Journal Saudi Medical Journal is copyright under the Berne Convention and the International Copyright Convention.  Saudi Medical Journal is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). Readers may copy, distribute, and display the work for non-commercial purposes with the proper citation of the original work. Electronic ISSN 1658-3175. Print ISSN 0379-5284.

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