Cognitive deficits associated with frontal-lobe infarction in children with sickle cell disease (SCD) were examined at the Institute of Child Health, London, UK. Of 41 with SCD who had MRIs, 5 with stroke symptoms had large frontal lobe (FL) infarcts, and 4 without symptoms had smaller FL infarcts. Those with stroke had significant impairments of IQ, memory, and FL function, on the Wisconsin Card Sorting Test (WCST), and those with covert infarction had lesser degrees of cognitive impairment. 
COMMENT. Covert infarcts in the frontal lobes may be defined by MRI in 10% of children with sickle cell anemia. The neurologic examination may be normal but cognitive tests may uncover deficits in IQ, memory, and frontal lobe function.