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Stroke Prevention in SCD — RACP Paediatrics MCQ

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HardNeurology & DevelopmentStroke Prevention in SCDRACP Paediatrics

A 3-year-old boy presents with an acute onset right hemiparesis. He has sickle cell disease (HbSS). CT brain shows a left middle cerebral artery territory infarct. What investigation should have been performed routinely to identify stroke risk?

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Correct answer: D — Transcranial Doppler ultrasonography

Transcranial Doppler (TCD) screening is recommended annually from age 2 years in children with SCD (HbSS/HbSβ0). Elevated TCD velocities (>200 cm/s) identify children at high risk of stroke who benefit from chronic transfusion therapy (STOP trial). This intervention reduces stroke risk from 11% to <1%.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Sickle Cell Disease