The etiology of stroke and its high prevalence in childhood is not understood, although hemiplegias are usually associated with blockage of major cerebral vessels such as the carotid, vertebral, anterior, or middle cerebral arteries. The mechanism whereby an essentially small-vessel disease gives rise to major arterial occlusion is not known. Once a stroke has occurred, the risk of recurrence is 50 to 70 per cent within 3 years of the first event. Subarachnoid hemorrhage, usually associated with aneurysms, is a common cause of cerebrovascular disease in adult homozygous sickle cell patients.
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