Researchers at Children’s Hospital of Philadelphia and Children’s Hospital of Michigan, Detroit, determined the frequency of acute care visits for headache in children with homozygous sickle cell disease (SCD-SS), neuroimaging studies, and associated CNS events. Of 2685 acute care visits by children with SCD-SS, 102 (3.8%) presented with headache as the chief complaint, and acute CNS events were diagnosed at 6.9% of these visits. Neuroimaging, performed in 42.2% of visits, identified acute CNS events in 16.3% of studies. Risk factors for acute CNS events that warrant confirmatory neuroimaging include older age, history of stroke, transient ischemic attack, or seizure, neurologic symptoms, focal neurologic exam, and elevated platelets. [1]

COMMENT. The authors recommend neuroimaging in children with SCD-SS who present with acute headache and have associated neurologic symptoms, focal findings on exam and /or a history of stroke, transient ischemic attack, or seizure, or elevated platelet count. Consider imaging in patients with atypical headache, abnormal transcranial Doppler, vasculopathy on MRA, and/or silent infarcts.