Abstract
<jats:p>Sickle cell disease is a hereditary hemoglobinopathy associated with significant neurological morbidity, with silent cerebral infarction emerging as one of its most frequent and underdiagnosed complications. Although clinically asymptomatic in the traditional sense, silent cerebral infarction is associated with a substantially increased risk of overt stroke and persistent cognitive deficits, directly impacting neuropsychological development and patients’ quality of life. This chapter analyzes recent advances in the identification of plasma and neurotrophic biomarkers, as well as the role of advanced neuroimaging techniques, in the early detection, prognostic stratification, and monitoring of silent cerebral infarction in individuals with sickle cell disease. Evidence suggests that inflammatory, thrombogenic, and neurotrophic biomarkers—such as thrombospondin-1, L-selectin, and neuregulin-1β—reflect states of cerebral vulnerability and an increased risk of subclinical injury. Concurrently, neuroimaging studies demonstrate that the impact of silent cerebral infarction extends beyond the volume of focal ischemic lesions, involving diffuse brain volume loss and widespread white matter alterations, which are often correlated with cognitive impairment. The integration of biomarkers and neuroimaging emerges as a promising strategy to enhance early diagnosis and clinical monitoring in these patients; however, its incorporation into routine clinical practice still requires methodological standardization and validation through large-scale multicenter studies.</jats:p>