Most people think of a stroke as something dramatic.
They picture face drooping, sudden paralysis, an ambulance. And yes, that is a stroke.
But there's another kind that causes just as much damage and announces itself with nothing at all.
A silent stroke happens when a small blood vessel in the brain becomes blocked, starving an area of brain cells of oxygen and causing damage.
And cause of that vessel blockage...?
Sickled red blood cells doing what they do best of course, blocking blood vessels.
The difference from a 'regular' stroke is that damage occurs in only a small part of the brain that doesn't disrupt any essential functions.
Therefore no obvious physical symptoms are produced.
No paralysis. No slurred speech. No emergency. Just a small silent event that tampers with your brain forever.
Of children with HbSS will have had at least one silent stroke by the time they reach adulthood. And many adults living with sickle cell have had several without knowing.
This is the question I hear most. The honest answer is that you wouldn't necessarily know – which is why it's worth paying attention to subtle patterns over time.
Common signs associated with silent stroke include:
These are easy to attribute to fatigue, chronic illness, or just life.
But if they are persistent or getting worse over time, they deserve a conversation with your medical team.
The only way to confirm a silent stroke has occurred is through an MRI brain scan. If you have concerns, ask your sickle cell team specifically about this, it's a reasonable and important question to raise.
Like old Rafiki says. You can't change the past. But you can learn from it.
And that means taking action to reduce the risk of further vessel damage.
Here's how:
Stay well hydrated EVERY day
Dehydration thickens the blood and increases sickling - one of the most direct triggers for vessel blockage.
Don't let that jumbo sized water bottle make it to the end of the day without finishing it!
Prioritise Haematology appointments
The most powerful tools are Exchange Blood Transfusion programmes and Hydroxyurea. If you're not already on them ask your sickle cell team whether these disease modifying treatments are right for you.
Get your blood pressure checked regularly
High blood pressure adds to the blood vessel damage already caused by sickle cell - especially in adults over 40.
Prioritise sleep
The brain clears waste and consolidates memory during deep sleep. Consistently poor sleep accelerates cognitive decline over time.
Your brain health is part of your sickle cell health.
Don't wait for dramatic symptoms to start protecting it.
Stay Healthy,
Lewis
