Birbeck, G. L., Green, R. September 3, 2017

Sometimes an important scientific report is more notable for what it cannot tell us than for what it can. In this issue of Neurology®, Noubiap and colleagues1 provide a comprehensive, well-conducted systematic meta-analysis of the neurologic complications of sickle cell disease (SCD) that incorporates rigorous design and advanced analytic methods to delineate in substantial detail what is known about the prevalence of neurologic injury among people with SCD in Africa—where over half the world’s population of people with SCD reside. As one might expect, based upon what is known from more medically developed regions of the world, stroke, seizures, and headache are common. Data within the African meta-analysis offer some insights into why the stroke prevalence rates identified are more similar to populations from advanced medical settings than expected, given the lack of universal availability of the 2 best tried and proven modalities of both primary and secondary stroke prevention—adequate maintenance of low sickle cell hemoglobin levels through regular transfusion and hydroxyurea in resource-impoverished areas of Africa.

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