MRI in sickle cell disease. (A) Coronal T1-weighted MRI, (B) coronal T2-weighted MRI, and (C-H) axial T2-weighted MRI in patients with homozygous SCA. (A-C) Silent cerebral infarction (white arrows) in the parietal white matter in a 10-year-old girl with headache. (D) Three years later, there is progressive atrophy on MRI in the context of intermittent ataxia and squint. (E-H) Four cases associated with acute illness. (E) Silent cerebral infarction (black arrows) in the watershed regions between the anterior, middle, and posterior regions, including the deep white matter, in a patient who had previously had posterior reversible encephalopathy syndrome in the context of cyclosporine treatment for nephrotic syndrome. (F) Bilateral watershed infarction in a child who had seizures in the context of a facial infection. Motor examination was normal but his IQ was reduced by 30 points compared with premorbid testing. (G) Encephalomalacia after sagittal sinus thrombosis secondary to pneumococcal meningitis. (H) Occipital infarction after acute chest crisis. A homonymous visual field defect was detected after the infarct was noted on MRI.