Neurological manifestations in Nigerian children with sickle cell disease: a single-center retrospective study.

BACKGROUND

Sickle cell disease (SCD) is a hereditary hemoglobinopathy that poses a significant public health problem in Nigeria, associated with significant morbidity and mortality among affected children. Neurological manifestations contribute substantially to disability and adverse outcomes, however, comprehensive data on their burden and determinants in pediatric SCD patients remain limited.

METHODS

This single-center retrospective study examined children under 15 years of age with confirmed SCD managed at Olabisi Onabanjo University Teaching Hospital (OOUTH) between March 2022 and February 2025. A structured proforma was used to extract demographic data, clinical history, neurological manifestations, associated factors, and outcomes. The neurological manifestations assessed included seizure, stroke, paralysis, headache, visual disturbance, and silent cerebral infarct. Laboratory and imaging data, where available, were used to support the diagnoses. Data were analyzed using descriptive and bivariate statistical methods.

RESULTS

Among the 133 children with SCD, 28 (21.1%) had documented neurological manifestations. Seizures were the most frequent (12.8%), followed by headaches (9.8%), paralysis (9.0%), and stroke (6.8%). Most neurological events occurred between 5 and 10 years of age, with a mean onset of 7.2 ± 3.8 years. Neurological manifestations were significantly associated with age at presentation (p = 0.032), higher frequency of crises (p = 0.02), and prior history of neurological manifestations (p < 0.001). No statistically significant associations were observed between neurological manifestations and sex (p = 0.232), anemia (p = 0.6), or infections (p = 0.812). Neurological manifestations were associated with increased mortality, residual deficits, and longer hospital stay. Neurological manifestations were present in half (n = 4) of all recorded deaths, with an overall mortality of 6% in the patients studied. Among survivors, approximately one-third had residual neurological deficits.

CONCLUSION

Neurological manifestations in children with SCD are relatively common and are associated with adverse outcomes, including disability and prolonged hospitalization. These findings underscore the urgent need for improved early detection and context-appropriate preventive and management strategies to reduce this burden in resource-limited settings.