Ischemic and Hemorrhagic Strokes in Dakar, Senegal

30-day in-hospital stroke case fatality and significant risk factors in sub-Saharan-Africa: A systematic review and meta-analysis

Existing studies investigating 30-day in-hospital stroke case fatality rates in sub-Saharan Africa have produced varying results, underscoring the significance of obtaining precise and reliable estimations for this indicator. Consequently, this study aimed to conduct a systematic review and update of the current scientific evidence regarding 30-day in-hospital stroke case fatality and associated risk factors in sub-Saharan Africa. Medline/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycNet (encompassing PsycINFO and PsychArticle), Google Scholar, and Africa Journal Online (AJOL) were systematically searched to identify potentially relevant articles. Two independent assessors extracted the data from the eligible studies using a pre-tested and standardized excel spreadsheet. Outcomes were 30-day in-hospital stroke case fatality and associated risk factors. Data was pooled using random effects model. Ninety-three (93) studies involving 42,057 participants were included. The overall stroke case fatality rate was 27% [25%-29%]. Subgroup analysis revealed 24% [21%-28%], 25% [21%-28%], 29% [25%-32%] and 31% [20%-43%] stroke case fatality rates in East Africa, Southern Africa, West Africa, and Central Africa respectively. Stroke severity, stroke type, untyped stroke, and post-stroke complications were identified as risk factors. The most prevalent risk factors were low (<8) Glasgow Coma Scale score, high (≥10) National Institute Health Stroke Scale score, aspiration pneumonia, hemorrhagic stroke, brain edema/intra-cranial pressure, hyperglycemia, untyped stroke (stroke diagnosis not confirmed by neuroimaging), recurrent stroke and fever. The findings indicate that one in every four in-hospital people with stroke in sub-Saharan Africa dies within 30 days of admission. Importantly, the identified risk factors are mostly modifiable and preventable, highlighting the need for context-driven health policies, clinical guidelines, and treatments targeting these factors.

Ischemic strokes revealing neurosyphilis: Study of six (6) observations at the neurology Department of the University Hospital of Conakry

Introduction

In sub-Saharan Africa (SSA), stroke is a major public health problem and the etiological aspects are poorly studied and documented because of under-medicalization; the syphilitic etiology is rarely mentioned.

Patients and methods

We performed a retrospective study of 472 patients hospitalized for ischemic stroke between 2016 and 2021 in the Neurology Department of the University Hospital of Conakry, confirmed by neuroradiological explorations (brain CT, MRI-Angio) and a biological workup including VDRL-TPHA serological reactions in blood and CSF.

Results

Syphilitic etiology was retained for six (6) patients (4 men and 2 women) with a mean age of 43 years (extremes 36 and 49 years). The clinical picture was dominated by carotid syndromes: superficial and deep sylvian syndrome, anterior cerebral artery syndrome and vertebro-basilar syndromes and one case of lacunar syndrome.The diagnosis was based on the positivity of serological reactions (VDRL-TPHA) in blood and cerebrospinal fluid (CSF) and the presence of a predominantly lymphocytic hypercellularity and a hyperproteinorachy in the CSF in the absence of any other etiology.

Conclusion

These neurological vascular syndromes consecutive to a cerebral treponematous attack are often the result of a still poorly conducted management of primary and secondary syphilis in our country.

The Burden and In-Hospital Mortality of Stroke Admissions at a Tertiary Level Hospital in Namibia: A Retrospective Cohort Study

Background

Despite stroke being a leading cause of morbidity and mortality globally, there is a dearth of information on the burden and outcomes of stroke in sub-Saharan Africa and Namibia in particular.

Methods

A hospital-based, retrospective cohort study was conducted to analyse non-electronic medical records of all consecutive stroke patients who were admitted to one of the highest tertiary-level hospitals in Namibia for 12 months (2019-2020). The primary outcome of the study was to establish the in-hospital mortality, stroke subtypes, and associated complications.

Results

In total, 220 patients were included in the study, their mean age was 53 (SD13.8) years, and 55.5% were males. 61.0% had an ischaemic stroke (IS), and 39.0% had a haemorrhagic stroke (HS). The mean age was significantly lower in patients with HS vs. IS (48.2 ± 12.2 vs. 56.1 ± 13.3, p < 0.001). Of the IS patients, the majority (29.0%) had total anterior circulation infarct (TACI), while in the HS group, 34.0% had basal ganglia haemorrhage with or without intraventricular extension. Hypertension (p = 0.015), dyslipidaemia (p = 0.001), alcohol consumption (p = 0.022), and other cardiovascular diseases (p = 0.007) were more prevalent in patients with IS compared to those with HS. The prevalence rate of intravenous thrombolysis was 2.2% in IS and use of intravenous antihypertensives in 25.9% of patients with HS than IS. The in-hospital mortality was 26.4% with complications such as raised ICP, aspiration pneumonia, hydrocephalus, and sepsis significantly high in those that died. Aspiration pneumonia (OR 2.79, 95% CI 1.63-4.76, p < 0.001) and increased ICP (OR 0.30, 95% CI 0.16-057, p < 0.001) were independent predictors of in-hospital mortality on the multivariate analysis.

Conclusion

Our findings showed a younger mean age for stroke and mortality rate comparable to other low- to middle-income countries (LMICs). Hypertension and alcohol consumption were the main risk factors for both stroke subtypes, while aspiration pneumonia and raised intracranial pressure predicted in-hospital mortality.

In-hospital treatment outcomes of acute stroke and determinant factors in a teaching hospital in eastern Ethiopia

Objective

To assess the in-hospital mortality of acute stroke and determinant factors in a teaching hospital in eastern Ethiopia.

Method

A retrospective review of medical records of patients admitted to Hiwot Fana Specialized University Hospital was conducted. Adult patients aged 18 years and older with a diagnosis of either ischemic or hemorrhagic stroke were included. Data were analyzed using SPSS version 21.0 (SPSS Inc., Chicago, IL, USA). Multiple logistic regression analysis was used to identify predictors of in-hospital mortality.

Result

A total of 112 patients with acute stroke were included in the study and 56.0% of them were of hemorrhagic stroke. The mean age was 60.32 years and 61.6% were male. The mean length of hospitalization and the mean time of presentation from symptoms onset were 4.85 days and 33.64 h, respectively. The in-hospital mortality was 36.8% for ischemic stroke and 27% for hemorrhagic stroke. Aspiration pneumonia (35.0%), cerebral edema (17%), and seizure (14.3%) were the most common complications occurring during hospitalization. Atrial fibrillation (adjusted odds ratio = 15.45, 95% confidence interval: 1.089-219.2; p = 0.043) was the independent predictor of in-hospital mortality.

Conclusion

Hemorrhagic stroke was predominant in the study sample. One-third of patients died in the hospital and the mortality rate was slightly higher in patients with ischemic stroke. Atrial fibrillation was the predominant risk factor for hospital mortality from acute stroke. There is a need to promote cardiovascular health, early recognition, and management of risk factors, and implement coordinated stroke care services to reduce premature death from stroke.

Risk Factors for Hemorrhagic Stroke among Adults in the Democratic Republic of the Congo: A Hospital-Based Study in a Limited Resource Setting

Background

The prevalence of stroke is increasing in sub-Saharan Africa. The scarcity of hospital-based stroke data in Lubumbashi (in the Democratic Republic of the Congo) led to the study, which was designed to describe the epidemiology of stroke and identify risk factors associated with hemorrhagic stroke among adult patients in Lubumbashi.

Methods

This was a cross-sectional study of 158 adult patients admitted for stroke in the internal medicine department of Lubumbashi University Clinics from January 2018 to December 2020. Sociodemographic and clinical features, cardiovascular risk factors, and hospital mortality were collected. A logistic regression has determined the risk of developing a hemorrhagic stroke.

Results

Of 9,919 hospitalized patients, 158 had a stroke with a hospital prevalence of 1.6%; 86 (54.4%) patients had a hemorrhagic stroke while 72 (45.6%) had an ischemic stroke. Of which 41.1% (65/158) were women. The mean age was 60.8 ± 13.3 years. Main clinical signs were hemiplegia (63.3%), headache (48.7%), speech disorders (38.6%), and dizziness (38.6%). Hypertension (82.9%) and hyperglycemia (53.2%) were the most common risk factors. Inhospital mortality was 22.8%. After logistic regression, independent predictors for developing hemorrhagic stroke were hypertension (aOR = 8.19; 95% CI: 2.72–24.66; p < 0.0001) and atrial fibrillation (aOR = 4.89; 95% CI: 1.41–16.89; p = 0.012).

Conclusion

This study highlights the high stroke mortality in a resource-limited hospital and the burden of hypertension in the development of hemorrhagic stroke. It illustrates the need to establish stroke care setting to improve the quality of stroke care.

Risk profile, clinical presentation, and determinants of stroke subtypes among patients with stroke admitted to public referral hospitals, Northwest Ethiopia in 2021: A cross-sectional study

Background

Stroke is the second leading cause of death worldwide, with a significant increase in stroke burden over the last two and half decades, especially in developing countries. African countries are undergoing an epidemiological transition from being dominated by infectious diseases to being double-burdened by non-communicable diseases, with existing infectious diseases driven by sociodemographic and lifestyle changes and a weak healthcare system. Data on the risk profile, clinical presentation, and predictors of stroke subtypes are still limited. Therefore, the main aim of this study was to assess the risk profile, clinical presentation, and predictors of stroke in public referral hospitals of Northwest Ethiopia.

Methods

For this study, 554 patients with stroke admitted to three public referral hospitals were prospectively followed up. Data were collected using a pre-tested interviewer-administered questionnaire. STATA version 16 was used for data analyses. Candidate variables significant in bivariate analysis were selected for multivariate binary logistic regression, and statistical significance was set at a p &lt; 0.05.

Results

Of the 554 patients with stroke, 60.3% had an ischemic stroke. The mean age of the participants was 61 ± 12.85 years, and more than half (53.25%) of them were women. The most common risk factor identified was hypertension (29.7%), followed by congestive heart failure. The most common clinical presentation was hemiparesis, which was reported by 57.7% of the patients, followed by loss of consciousness (20.7%) and aphasia (9%). Through multivariable logistic regression, age (AOR = 1.03, 95% CI:1.01–1.05), sedentary physical activity level (AOR = 6.78, 95% CI:1.97–23.32), absence of a family history of chronic illness (AOR = 3.79, 95% CI:2.21–6.48), hypertension (AOR=0.51, 95% CI:0.31–0.85), and past stroke (AOR = 3.54, 95% CI:0.93–13.49) were found to be independent determinants of the stroke subtype.

Conclusion

Age, the level of sedentary physical activity, absence of a family history of chronic illness, hypertension, and past stroke were independent determinants of stroke subtype.

Case fatality rate and its determinants among admitted stroke patients in public referral hospitals, Northwest, Ethiopia: A prospective cohort study

According to the global burden of disease 5.5 million deaths were attributable to stroke. The stroke mortality rate is estimated to be seven times higher in low-income countries compared to high-income countries. The main aim of the study was to assess the 28 days case fatality rate and its determinants among admitted stroke patients in public referral hospitals, in Northwest Ethiopia. A hospital-based prospective cohort study was conducted from December 2020 to June 2021. The study population was 554 stroke patients. Based on Akakian Information Criteria, the Gompertz model was fitted to predict the hazard of death. The study included admitted stroke patients who were treated in the general medical ward and neurology ward. The mean age of the participants was 61 ± 12.85 years and 53.25% of the patients were female. The 28-days case fatality rate of stroke was 27.08%. The results from Gompertz parametric baseline hazard distribution revealed that female sex adjusted hazard rate (AHR = 0.27, 95% CI:0.18–0.42), absence of a family history of chronic disease (AHR = 0.50, 95%CI:0.29–0.87), good GCS score (AHR = 0.21, 95% CI:0.09–0.50) and the absence of complication during hospital admission (AHR = 0.16, 95% CI:0.08–0.29) were factors which decrease hazard of 28 days case fatality rate. While, hemorrhagic stroke sub-type (AHR = 1.38, 95% CI:1.04–3.19), time from symptom onset to hospital arrival (AHR = 1.49, 95% CI:1.57–2 .71), time from confirmation of the diagnosis to initiation of treatment (AHR = 1.03, 95% CI:1.01–1.04), a respiratory rate greater than 20 (AHR = 7.21, 95% CI:3.48–14.9), and increase in NIHSS score (AHR = 1.16, 95% CI:1.10–1.23) were factors increasing hazard of 28 days case fatality rate of stroke. At 28-days follow-up, more than one-fourth of the patients have died. The establishment of separate stroke centers and a network of local and regional stroke centers with expertise in early stroke evaluation and management may address challenges.

Ischemic Stroke and SARS-CoV-2 Infection: The Bidirectional Pathology and Risk Morbidities

Stroke is a fatal morbidity that needs emergency medical admission and immediate medical attention. COVID-19 ischemic brain damage is closely associated with common neurological symptoms, which are extremely difficult to treat medically, and risk factors. We performed literature research about COVID-19 and ischemia in PubMed, MEDLINE, and Scopus for this current narrative review. We discovered parallel manifestations of SARS-CoV-19 infection and brain ischemia risk factors. In published papers, we discovered a similar but complex pathophysiology of SARS-CoV-2 infection and stroke pathology. A patient with other systemic co-morbidities, such as diabetes, hypertension, or any respiratory disease, has a fatal combination in intensive care management when infected with SARS-CoV-19. Furthermore, due to their shared risk factors, COVID-19 and stroke are a lethal combination for medical management to treat. In this review, we discuss shared pathophysiology, adjuvant risk factors, challenges, and advancements in stroke-associated COVID-19 therapeutics.

Ultrasound-gated computed tomography coronary angiography: Development of ultrasound transducers with improved computed tomography compatibility

PURPOSE

Cardiovascular disease (CVD) is a leading cause of death worldwide, with coronary artery disease (CAD) accounting for nearly half of all CVD deaths. The current gold standard for CAD diagnosis is catheter coronary angiography (CCA), an invasive, expensive procedure. Computed tomography coronary angiography (CTCA) represents an attractive non-invasive alternative to CCA, however, CTCA requires gated acquisition of CT data during periods of minimal cardiac motion (quiescent periods) to avoid non-diagnostic scans. Current gating methods either expose patients to high levels of radiation (retrospective gating) or lead to high rates of non-diagnostic scans (prospective gating) due to the challenge of predicting cardiac quiescence based on ECG alone. Alternatively, ultrasound (US) imaging has been demonstrated as an effective indicator of cardiac quiescence, however, ultrasound transducers produce prominent streak artifacts that disrupt CTCA scans. In this study, a proof-of-concept array transducer with improved CT-compatibility was developed for utilization in an integrated US-CTCA system.

METHODS

Alternative materials were tested radiographically and acoustically to replace the radiopaque acoustic backings utilized in low frequency (1-4 MHz) cardiac US transducers. The results of this testing were used to develop alternative acoustic backings consisting of varying concentrations of aluminum oxide in an epoxy matrix via simulations. On the basis of these simulations, single element test transducers designed to operate at 2.5 MHz were fabricated, and the performance of these devices was characterized via acoustic and radiographic testing with micro-computed tomography (micro-CT). Finally, a first proof-of-concept cardiac phased array transducer was developed and its US imaging performance was evaluated. Micro-CT images of the developed US array with improved CT-compatibility were compared with those of a conventional array.

RESULTS

Materials testing with micro-CT identified an acoustic backing with a measured radiopacity of 1008 HU, more than an order of magnitude lower than that of the acoustic backing (24,000 HU) typically used in cardiac transducers operating in the 1-4 MHz range. When utilized in a simulated transducer design, this acoustic backing yielded a -6-dB fractional bandwidth of 57%, similar to the 54% bandwidth of the transducer with the radiopaque acoustic backing. The developed 2.5 MHz, single element transducer based on these simulations exhibited a fractional bandwidth of 51% and signal-to-noise ratio (SNR) of 14.7 dB. Finally, the array transducer developed with the acoustic backing having decreased radiopacity exhibited a 56% fractional bandwidth and 10.4 dB single channel SNR, with penetration depth >10 cm in phantom and in vivo imaging using the full array.

CONCLUSIONS

The first attempt at developing a CT-compatible ultrasound transducer is described. The developed CT-compatible transducer exhibits improved radiographic compatibility relative to conventional cardiac array transducers with similar SNR, bandwidth, and penetration depth for US imaging, according to phantom and in vivo cardiac imaging. A CT-compatible US transducer might be used to identify cardiac quiescence and prospectively gate CTCA acquisition, reducing challenges associated with current gating approaches, specifically relatively high rates of non-diagnostic scans for prospective ECG gating and high radiation dose for retrospective gating.

Characteristics and Risk Factors Associated with Stroke Subtypes among Adult Patients Admitted to the Stroke Unit of Jimma University Medical Center: A Retrospective Cross-sectional Study

BACKGROUND

Almost 80% of deaths due to non-communicable diseases occur in lowand middle-income countries. Stroke is a great public health problem in Ethiopia. Stroke mortality was estimated to be 14.7% in Ethiopia. Despite this, researches done in Ethiopia on factors associated with stroke sub-types were inadequate.

OBJECTIVE

To assess the characteristics and risk factors associated with stroke subtypes among patients admitted to Jimma University Medical Center.

MATERIALS AND METHODS

A retrospective cross-sectional study was conducted from May 2017 to May 2018 in the stroke unit of the Jimma University Medical Center. A total of 106 medical charts of patients diagnosed with stroke were reviewed. A checklist comprising relevant variables was used to collect data. SPSS version 21 was employed for data entry and analysis. Pearson chi-square test was used to check the association of different parameters with stroke subtypes. A P-value <0.05 was used as a cutoff point to declare statistical significance. Data were presented using text, tables, and figures.

RESULTS

From a total of 106 patients, 67 (63.2%) were men. The mean ± SD of age was 52.67±12.46 Year's, and the difference was not significant among stroke subtypes. Among all patients, 59 (55.6%) had ischemic strokes and 47 (44.4%) had hemorrhagic strokes. The most prevalent risk factors significantly associated with stroke subtypes were being male 67 (63.2%) followed by dyslipidemia 43 (40.5%) and cigarette smoking 38 (35.8%).

CONCLUSION

The ischemic stroke was reported to be higher than hemorrhagic in this study. The overall mean (±SD) age of the patient was 52.67±(12.46) years. The mean age of hemorrhagic stroke patients was 55.98 (±13.77) years; while in ischemic stroke was 50.03 (±10.70) years. Being male, a history of cigarette smoking, and dyslipidemia were significantly associated with stroke subtypes.

Knowledge on Prevention of Stroke and Its Associated Factors Among Hypertensive Patients at Debre Tabor General Hospital: An Institution-Based Cross-Sectional Study

Introduction

Globally, stroke is the second leading cause of death. About 70% of strokes were occurring in low- and middle-income countries, and high blood pressure is the main risk factor of stroke due to its poor recognition of stroke prevention methods. Therefore, the study aimed to assess knowledge on stroke prevention and its associated factors among hypertensive patients at Debre-Tabor General Hospital, Northwest Ethiopia, 2020.

Methods

An institutional-based cross-sectional study was conducted in Debre-Tabor General Hospital from February 20 to March 20/2020. A systematic random sampling technique was used. Data were collected through an interviewer-administered questionnaire. Data were entered into Epi data version 4.2.0.0 and exported to SPSS version 25 for cleaning and analysis. A reliability test was done, and the Cronbach alpha coefficient value was 0.709. Bivariate and multivariable binary logistic regression analyses were done, and variables with a p-value of ≤0.05 in the multivariable analysis were considered as statistically significant at a 95% confidence interval.

Results

From 423 study participants, 410 of them responded completely and a response rate is 96.92%. Among the total respondents, 24.9% (95% CI: 20.7, 29.3) of participants had good knowledge of stroke prevention methods. Young age (AOR: 2.082; 95% CI (1.071, 4.049)), urban residence (AOR: 3.230; 95% CI (1.665, 6.267)), and having long followed-up duration (AOR: 3.015; 95% CI (1.870, 4.861)) were factors associated with good knowledge on stroke prevention methods.

Conclusion

This study revealed that participants had poor knowledge of stroke prevention. Young age, urban residence, and having long duration hypertension follow-up were predictors of good knowledge on stroke prevention. These findings have immense importance of different stakeholders that have responsibilities on the reduction of hypertension complications characteristically stroke. Further, it is chief for health-care providers for hypertension intervention activities.

Stroke in Africa: profile, progress, prospects and priorities

Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.

Clinical pattern and predictors of stroke treatment outcome among hospitalised patients who had a stroke at Felege Hiwot comprehensive specialised hospital, northwest Ethiopia: a retrospective cross-sectional study

OBJECTIVES

This study aimed to assess the clinical pattern and predictors of stroke treatment outcomes among hospitalised patients in Felege Hiwot comprehensive specialised hospital (FHCSH) in northwest Ethiopia.

DESIGN

A retrospective cross-sectional study.

SETTING

The study was conducted medical ward of FHCSH.

PARTICIPANTS

The medical records of 597 adult patients who had a stroke were included in the study. All adult (≥18 years) patients who had a stroke had been admitted to the medical ward of FHSCH during 2015-2019 were included in the study. However, patients with incomplete medical records (ie, incomplete treatment regimen and the status of the patients after treatment) were excluded in the study.

RESULTS

In the present study, 317 (53.1%) were males, and the mean age of the study participants was 61.08±13.76 years. About two-thirds of patients (392, 65.7%) were diagnosed with ischaemic stroke. Regarding clinical pattern, about 203 (34.0%) of patients complained of right-side body weakness and the major comorbid condition identified was hypertension (216, 64.9%). Overall, 276 (46.2%) of them had poor treatment outcomes, and 101 (16.9%) of them died. Patients who cannot read and write (AOR=42.89, 95% CI 13.23 to 111.28, p<0.001), attend primary school (AOR=22.11, 95% CI 6.98 to 55.99, p<0.001) and secondary school (AOR=4.20, 95% CI 1.42 to 12.51, p<0.001), diagnosed with haemorrhagic stroke (AOR=2.68, 95% CI 1.62 to 4.43, p<0.001) and delayed hospital arrival more than 24 hours (AOR=2.92, 95% CI 1.83 to 4.66, p=0.001) were the independent predictors of poor treatment outcome.

CONCLUSIONS

Approximately half of the patients who had a stroke had poor treatment outcomes. Ischaemic stroke was the most predominantly diagnosed stroke type. Education status, types of stroke and the median time from onset of symptoms to hospitalisation were the predictors of treatment outcome. Health education should be given to patients regarding clinical symptoms of stroke. In addition, local healthcare providers need to consider the above risk factors while managing stroke.

Systemic disorders and the prognosis of stroke in Congolese patients: a cross-sectional study

OBJECTIVES

Stroke is one of the leading causes of death, disability, and dementia in developing countries. Our study aimed to evaluate the systemic disorders associated with mortality in patients admitted within 72 hours of the initial stroke event.

SETTING

The study took place at a tertiary hospital in Kinshasa.

PARTICIPANTS

Patients admitted within 72 hours of the initial stroke event.

INTERVENTIONS

This cross-sectional study consisted of a retrospective review of stroke patient records from January 2016 to December 2018. The Pearson-Chi square test and odds ratios were calculated with a threshold of significance of 0.05.

MAIN OUTCOME MEASURES

Mortality.

RESULTS

We recruited 114 cases. The mean age was 61.8 ± 2.4 years, and the sex ratio was 1.78 in favor of men. Hypertension (76.3%), dyslipidemia (71.1%), and diabetes mellitus (58.8%) were the most frequent comorbidities. Most patients had hypoxia (85.9%), hypertension (82.4%), hyperglycemia (57.8%), and fever (28.1%). We registered thirty-two deaths (28.1%): 20 (62.5%) from the ischemic strokes, and 12 (37.5%) from hemorrhagic strokes. Systemic disorders with the worst prognosis during were arterial hypotension (OR=3.87, p >0.001), and fever (OR =1.56, p = 0.047).

CONCLUSION

Arterial hypotension and fever adversely affect stroke patient outcomes, and strokes are responsible for high mortality in Congo.

FUNDING

Not applicable.

Acute Ischemic and Hemorrhagic Stroke and COVID-19: Case Series

The coronavirus COVID-19 pandemic is the defining global health crisis of our time and the greatest challenge we have faced since the World Wars; it can attack several systems in the body and has high complications and mortality. COVID-19 can cause venous and arterial thromboembolism due to immobility, high inflammation, extensive intravascular blood coagulation, and hypoxia. In this study, we report 5 cases of adults with COVID-19, hospitalized in Tohid Hospital, Sanandaj, Iran. Three patients were male and two were female. The youngest patient was 20 years old and the oldest was 55 years old. All patients had at least one family member with coronavirus. Fever, chills, muscular pain, cough, and tachypnea were present in all patients. Red blood cell (RBC) was observed in all patients at a low level. Computed tomography (CT) scans of all patients showed abnormal findings in different areas of the brain. These cases indicate that COVID-19 may damage blood vessels in the brain and lead to stroke.

30-day and 60-day rates and predictors of mortality among adult stroke patients: Prospective cohort study

Stroke is one of the most common medical emergencies and the leading cause of preventable death and long-term disability worldwide. A prospective cohort study was conducted at the stroke unit of Jimma university medical center for four consecutive months (from March 10 to July 10, 2017). Of the total 116 study patients, 60 (51.7%) had an ischemic stroke. At 30-day follow-up, 81 (69.8%) patients were alive, 34 (29.3%) were died, and one patient (0.9%) was lost to follow-up. Elevated alanine aminotransferase (ALT) level (AHR: 3.77, 95% CI: 1.34-10.57), diagnosis of stroke clinically alone (AHR: 3.90, 95 CI: 1.49-10.26), brain edema (AHR: 4.28, 95% CI: 1.61-11.37), and National Institute of Health Stroke Scale (NIHSS) ≥ 13 during hospital arrival (AHR: 6.49, 95% CI: 1.90-22.22) were the independent predictors of 30-day mortality. At 60-day follow-up, 68 (58.6%) patients were alive, 46 (39.7%) were died, and 2 (1.7%) were lost to follow-up. Discharge against medical advice (AHR: 6.40, 95% CI: 2.31-17.73) and severe modified Rankin score/mRS (4-5) at discharge (AHR: 3.64, 95% CI: 1.01-13.16) were the independent predictors of 60-day mortality. The median (IQR) length of survival after hospital admission for patients died within 30 and 60 days were 4.65 (2.34-11.80) and 9.3 (3.93-33) days, respectively. Stroke significantly affects the morbidity and mortality in Ethiopia. There is a need to provide better care and future planning for stroke patients as an emergency diagnosis and treatment to minimize mortality and disability.

Post-stroke Complications and Mortality in Burkinabè Hospitals: Relationships with Deglutition Disorders and Nutritional Status

Stroke frequently causes deglutition disorders, leading to a decline in nutritional status and complications, and increasing mortality. Sub-Saharan data are scarce. The objectives of this study were to assess complications and mortality among hospitalized patients in Burkina Faso during the first two weeks after stroke, and to investigate associated factors. Patients with stroke were followed prospectively in Ouagadougou and Bobo-Dioulasso hospitals. Deglutition disorders and nutritional parameters were assessed at baseline (D0) and on Days 8 (D8) and 14 (D14). Complications and mortality were recorded up to D14. Factors associated with complications and mortality were investigated using multivariate analysis. Of the 222 patients included, 81.5% developed at least one complication, and mortality was 17.1%. At D0, D8, and D14, the rate of deglutition disorders was 37.4%, 28.4%, and 15.8%, respectively, and that of undernourishment 25.2%, 29.4%, and 31.0%, respectively. In multivariate analysis, only the presence of deglutition disorders was a risk factor for developing at least one complication (OR = 5.47, 95% CI 1.81-16.51). Factors predicting death were the presence of deglutition disorders at D0 (OR = 7.19, 95% CI 3.10-16.66), and at least one seizure during follow-up (OR = 3.69, 95% CI 1.63-8.36). After stroke, the rates of complications, death, and undernourishment were high compared to Western countries. Prevention and management of deglutition disorders, and specific follow-up of patients with seizures could reduce post-stroke mortality.

Clinical characteristics and treatment outcomes among stroke patients hospitalized to Nekemte referral hospital, western Ethiopia

OBJECTIVES

Stroke is the brain equivalent of a heart attack. It is one of the most common causes of morbidity and mortality worldwide and is a prominent cause of death, disability and dementia in sub-Saharan Africa (SSA). Hence, the purpose of this study was to assess the clinical characteristics and treatment outcomes among hospitalized stroke patients at Nekemte referral hospital (NRH).

PATIENTS AND METHODS

Retrospective cross sectional study design was conducted on randomly selected stroke patients admitted to medical wards of NRH from 2013 to 2017.

RESULTS

Among 364 patients included in the study, 208 (57.1%) were males and the mean age of the patients was 59.66 ± 13.4 years. Regarding types of stroke, 192 (52.7%) were diagnosed as having ischemic stroke. During admission 132 (36.3%) patients complained left side body weakness (hemiparesis) and the major risk factor identified was hypertension 230 (63.2%). Overall, 65.4% of patients had poor outcome while 34.6% of patients had good out comes (improved). Being illiterate /unable to read and write (AOR = 3.94, 95% CI: 1.31-11.76, P = 0.01), attending secondary school (AOR = 3.6, 95% CI: 1.4-9.17, P = 0.007) and length of hospital stay >5 days (AOR = 2, 95% CI: 1.04-3.86, P = 0.037) were independent predictors of poor treatment outcome.

CONCLUSION

About two third of the patients had poor treatment outcome. Educational status and mean length of hospital stays were independent predictors of poor treatment out-comes. An emergency care setup capable of early patient evaluation, identification and management of stroke complications is crucial to overcome early stroke related mortality.

Risk factors, clinical presentations and predictors of stroke among adult patients admitted to stroke unit of Jimma university medical center, south west Ethiopia: prospective observational study

Background

Stroke is the second-leading global cause of death behind heart disease in 2013 and is a major cause of permanent disability. The burden of stroke in terms of mortality, morbidity and disability is increasing across the world. It is currently observed to be one of the commonest reasons of admission in many health care setups and becoming an alarming serious public health problem in our country Ethiopia. Despite the high burden of strokes globally, there is insufficient information on the current clinical profile of stroke in low and middle income countries (LMICs) including Ethiopia. So, this study was aimed to assess risk factors, clinical presentations and predictors of stroke subtypes among adult patients admitted to stroke unit of Jimma university medical center (JUMC).

Methods

Prospective observational study design was carried out at stroke unit (SU) of JUMC for 4 consecutive months from March 10–July 10, 2017. A standardized data extraction checklist and patient interview was used to collect data. Data was entered into Epi data version 3.1 and analyzed using SPSS version 20. Multivariable logistic regression was used to identify the predictors of stroke subtypes.

Result

A total of 116 eligible stroke patients were recruited during the study period. The mean age of the patients was 55.1 ± 14.0 years and males comprised 62.9%. According to world health organization (WHO) criteria of stroke diagnosis, 51.7% of patients had ischemic while 48.3% had hemorrhagic stroke. The most common risk factor identified was hypertension (75.9%) followed by family history (33.6%), alcohol intake (22.4%), smoking (17.2%) and heart failure (17.2%). The most common clinical presentation was headache complained by 75.0% of the patients followed by aphasia 60.3% and hemiparesis 53.4%. Atrial fibrillation was the independent predictor of hemorrhagic stroke (AOR: 0.08, 95% CI: 0.01–0.68).

Conclusion

The clinical characteristics of stroke in this set up were similar to other low- and middle-resource countries. As stroke is a high priority chronic disease, large-scale public health campaign should be launched focusing on public education regarding stroke risk factors and necessary interventions.

Electronic supplementary material

The online version of this article (10.1186/s12883-019-1409-0) contains supplementary material, which is available to authorized users.

Risk factors, clinical presentations and predictors of stroke among adult patients admitted to stroke unit of Jimma university medical center, south west Ethiopia: prospective observational study

Background

Stroke is the second-leading global cause of death behind heart disease in 2013 and is a major cause of permanent disability. The burden of stroke in terms of mortality, morbidity and disability is increasing across the world. It is currently observed to be one of the commonest reasons of admission in many health care setups and becoming an alarming serious public health problem in our country Ethiopia. Despite the high burden of strokes globally, there is insufficient information on the current clinical profile of stroke in low and middle income countries (LMICs) including Ethiopia. So, this study was aimed to assess risk factors, clinical presentations and predictors of stroke subtypes among adult patients admitted to stroke unit of Jimma university medical center (JUMC).

Methods

Prospective observational study design was carried out at stroke unit (SU) of JUMC for 4 consecutive months from March 10–July 10, 2017. A standardized data extraction checklist and patient interview was used to collect data. Data was entered into Epi data version 3.1 and analyzed using SPSS version 20. Multivariable logistic regression was used to identify the predictors of stroke subtypes.

Result

A total of 116 eligible stroke patients were recruited during the study period. The mean age of the patients was 55.1 ± 14.0 years and males comprised 62.9%. According to world health organization (WHO) criteria of stroke diagnosis, 51.7% of patients had ischemic while 48.3% had hemorrhagic stroke. The most common risk factor identified was hypertension (75.9%) followed by family history (33.6%), alcohol intake (22.4%), smoking (17.2%) and heart failure (17.2%). The most common clinical presentation was headache complained by 75.0% of the patients followed by aphasia 60.3% and hemiparesis 53.4%. Atrial fibrillation was the independent predictor of hemorrhagic stroke (AOR: 0.08, 95% CI: 0.01–0.68).

Conclusion

The clinical characteristics of stroke in this set up were similar to other low- and middle-resource countries. As stroke is a high priority chronic disease, large-scale public health campaign should be launched focusing on public education regarding stroke risk factors and necessary interventions.

Electronic supplementary material

The online version of this article (10.1186/s12883-019-1412-5) contains supplementary material, which is available to authorized users.

Hypertensive Patients' Knowledge of Risk Factors and Warning Signs of Stroke at Felege Hiwot Referral Hospital, Northwest Ethiopia: A Cross-Sectional Study

Background

Stroke is a neurological condition which is a major cause of death and disability in many low- and middle-income countries. However, several modifiable risk factors are becoming significant. Hypertension is the most common stroke risk factor globally as well as in our country, Ethiopia.

Objective

The aim of this study was to assess hypertensive patients' knowledge of risk factors and warning signs of stroke at Felege Hiwot Referral Hospital, Northwest Ethiopia, 2018.

Method

An institutional based cross-sectional study design was conducted in May 01–30/2018. A total of 278 hypertensive patients were enrolled and systemic random sampling technique was employed to select the study participants. Data was collected through an interviewer-administered questionnaire. The collected data was entered into Epi info 7 and exported to SPSS version 22 for analysis. Binary and multivariable logistic regressions were used and P value ≤ 0.05 was considered as statistically significant.

Result

Out of the total 284 selected hypertensive patients, 278 of them responded completely with a response rate of 97.9 %. Of these, more than three fourths, 214 (77%) and 201 (72.3%), of them did not identify any risk factors and warning signs of stroke, respectively, with an overall proportion of only 18.3% of them having good knowledge towards stroke. Risk factor of stroke most commonly known to the respondents was physical inactivity (21.58%), whereas hypertension was the least described risk factor (3.6%). Regarding stroke warning signs, sudden weakness on one side of the body (35.97%) was the most commonly known warning sign of stroke to the respondents. Being able to read and write, being young, urban residence, and having sufficient monthly income were significantly associated with the overall knowledge of hypertensive patients towards stroke. These findings suggest the need for emphasizing on stroke education regarding its risk factors and warning signs through public or social media and health education targeting to low-income high risk subjects.

Stroke Event Factors among Adult Patients Admitted to Stroke Unit of Jimma University Medical Center: Prospective Observational Study

Background

The fact that the majority of patients come late creates management difficulties as these first hours are important to avoid secondary insults to the brain and preserve the ischemic penumbra. Although thrombolytic treatments are currently not available in our hospital, significant delays during the prehospital or in-hospital phases of care create management difficulties and would make such advanced treatments impossible in the future in Ethiopia.

Methods

Prospective observational study was carried at stroke unit of Jimma University Medical Center for 4 consecutive months from March 10 to July 10, 2017. Data was cleaned and entered to Epidata version 3.1 and then exported and analyzed using SPSS version 20.0.

Results

A total of 116 eligible stroke patients were recruited during the study period with mean age of 55.1±14.0 years, ranging from 23 to 96 years. The majority of stroke patients were males (62.9%) and from rural areas (72.4%). The median time elapsed between the onset of stroke symptoms and arrival to the hospital was 27 hours. Almost half (47.4%) of the patients presented within 24 hours and 26 (22.4%) patients presented to hospital beyond 72 hours. Majority of patients (40.5%) showed severe neurological deficit on admission and the mean National Institute of health stroke scale (NIHSS) was 15.71 ± 7.52. The mean Glasgow coma scale (GCS) was moderate (12.12±3.35). On hospital arrival systolic blood pressure (SBP) was highly elevated (≥140 mm Hg) in 65.5% of the patients. The circadian pattern showed a significant peak in morning for hemorrhagic stroke (35.7%) and afternoon for ischemic stroke (38.3%).

Conclusions

The delay of hospital arrival was a challenge similar to other high income countries for early management of the patients. Studies that attempt to determine some of the factors that impede timely presentation in patients with strokes are advisable to address those issues further.

Stroke in Human Immunodeficiency Virus-infected Individuals in Sub-Saharan Africa (SSA): A Systematic Review

BACKGROUND

Human immunodeficiency virus (HIV) infection is associated with worse outcomes after stroke, but this association is less well-described in sub-Saharan Africa (SSA). We reviewed literature on stroke among people living with HIV (PLWH) in SSA.

METHODS

We systematically reviewed published literature for original clinical stroke studies conducted in SSA that included PLWH. We included studies that reported data on presenting characteristics, risk factors, and/or outcomes after stroke.

RESULTS

Seventeen studies (N = 478) met inclusion criteria. At the time of stroke presentation, PLWH had a median age ranging from 32 to 43 years. Subjects had low CD4 counts (median CD4, 108-225 cells/µl), and most were antiretroviral therapy-naïve. Fever, seizures, and concurrent opportunistic infections were common at presentation. Ischemic stroke accounted for up to 96% of strokes, which were mostly located in the anterior circulation territory. In studies comparing PLWH with HIV-uninfected individuals, PLWH had more frequent coagulopathy, greater stroke severity, (72% versus 36% National Institutes of Health Stroke Scale >13, P = .02), longer hospital length of stay (30.5 versus <10 days), and a higher 30-day mortality rate (23% versus 10.5%, P = .007).

CONCLUSION

Stroke in PLWH in SSA occurs at a young age, in those with advanced disease, and is associated with worse outcomes than in HIV-uninfected comparators. Stroke in young individuals in the region should prompt HIV testing, and ongoing efforts to promote early antiretroviral therapy initiation might also help decrease stroke incidence, morbidity, and mortality in the region.

Risk Factors for Hemorrhagic and Ischemic Stroke in Sub-Saharan Africa

INTRODUCTION

In sub-Saharan Africa (SSA), there is a significant burden of ischemic stroke (IS) and hemorrhagic stroke (HS), although data on risk factors for each type are sparse. In this systematic review we attempt to characterize the risk factors.

METHODS

We systematically reviewed (PubMed, EMBASE, WHOLIS, Google Scholar, Wiley online, and the Cochrane Central Register of Controlled Trials (CENTRAL)) case-control studies and case series from 1980 to 2016 that reported risk factors for IS and/or HS in SSA. For each risk factor we calculated random-effects pooled odds ratios (ORs) for case-control studies and pooled prevalence estimates for case series. Results. We identified 12 studies, including 4,387 stroke patients. Pooled analysis showed that patients who had diabetes (OR = 2.39; 95% CI: 1.14-5.03) and HIV (OR = 2.46 (95% CI: 1.59-3.81) were at a significantly greater risk of suffering from all stroke types. There were insufficient data to examine these factors by stroke type. Among case series, the pooled prevalence of hypertension was higher for HS than for IS (73.5% versus 62.8%), while diabetes mellitus (DM) and atrial fibrillation (AF) were more prevalent among IS compared to HS (15.9% versus 10.6% and 9.6% versus 2.3%, respectively).

CONCLUSIONS

There remain too few data from SSA to reliably estimate the effect of various factors on the risk of IS and HS. Furthermore, the vast majority of cases were identified in hospital and so are unlikely to be representative of the totality of stroke cases in the community.

Ischemic and Hemorrhagic Stroke in Bahir Dar, Ethiopia: A Retrospective Hospital-Based Study

INTRODUCTION

The epidemiology of stroke in sub-Saharan countries is poorly characterized because of lack of population-based studies and national vital statistics systems with complete death registration.

OBJECTIVE

To describe risk factors, clinical presentations, the pattern of brain insult, and outcomes of stroke patients admitted to a hospital in Ethiopia.

METHOD

A retrospective hospital-based study was conducted on 508 patients, 303 of whom had computed tomography proven stroke, who were admitted to medical wards of Felege Hiwot Referral Hospital, Bahir Dar Ethiopia, from February 2014 to August 2016.

RESULTS

From 508 patients with a clinical diagnosis of stroke, 303 patients had computed tomography and complete medical record. Of the latter, 63% were male and 32% were in the age group 61-70 years. The most common initial clinical presentation was hemiplegia (61%). Common risk factors documented with stroke were hypertension (36.3%), dyslipidemia (20.4%), atrial fibrillation (12.2%), and structural cardiac disease (9.2%). Ischemic stroke comprised 59.4%, whereas 40.6% were hemorrhagic stroke. Only 3.6% patients arrived at the hospital within 3 hours of onset of clinical symptoms. Among subjects with preexisting treated hypertension, 56% had discontinued antihypertensive medications. One third of patients with atrial fibrillation were on warfarin or aspirin. In-hospital mortality rate was 11%. The cerebral cortex was affected in 36.6%.

CONCLUSION

Poor adherence to drugs and uncontrolled high blood pressure might have resulted in a high proportion of hemorrhagic stroke. Use of anticoagulants for atrial fibrillation should be standard in patient with risk factors for stroke in Ethiopia.

Clinical characteristics and outcomes of patients with stroke admitted to three tertiary hospitals in Zimbabwe: A retrospective one-year study

BACKGROUND

Epidemiological data on stroke in Zimbabwe are scarce and few clinical studies have been performed to date.

METHODS

A retrospective review of the medical records of patients admitted for stroke during the year 2012 was performed at three tertiary hospitals. Sociodemographic data were recorded alongside with comorbidities and outcomes. Scoping over a period of one year using records of patients admitted for stroke helped to quantify and qualify the stroke problem. Descriptive analysis was done using STATA version 13.0.

RESULTS

A total of 450 stroke cases, (63% women) were included in the final analysis. The proportion of stroke cases among the admissions was 0.61%. Mean age of the stroke patients was 61.6±16.8 years (95% CI=60.1; 63.2). Risk factors were hypertension (58.5%), diabetes (18%) and HIV, (14%)). Diagnosis was clinical and 39.4% had a CT scan. Mean length of hospital stay was 8.1±5.6 days with a significance difference noted among hospitals (p<0.001). In-hospital mortality was 24.9%, 95% CI (20.9; 29.0%). Mortality was associated with place of admission (p<0.001). Gender and side of stroke were significantly associated (p<0.001).

CONCLUSIONS

The sociodemographic characteristics mirrored findings from elsewhere. Mean age was higher than reported for Zimbabwe in the nineties and lately for Malawi. Majority of patients were female, elderly and hypertensive in line with findings from other countries. Presence of HIV is supported by recent studies from Malawi and South Africa. The relationship between gender and side affected needs further research. There is need to standardise acute care through proper diagnosis to reduce mortality. There is need to support caregivers post-discharge. Data-handling is poor and there is limited capacity for Sub Saharan Africa hospitals to provide optimal stroke care. This may have long term implications on the outcome of survivors and caregivers. There is need of vigilance in acute stroke care.

The Neglected Burden of Stroke in Sub-Saharan Africa

The looming epidemic of stroke and other chronic non-communicable diseases associated with lifestyle and demographic transitions occurring all over the world is increasingly being acknowledged. However, the significance of these trends in the relatively young populations of the countries comprising Sub-Saharan Africa (SSA) is less certain and considerably overshadowed by attention given to the impact of human immunodeficiency virus and other infectious diseases. We undertook a literature review of the burden of stroke in SSA and provide recommendations for future research. Despite the paucity of high quality studies, the mostly hospital-based data and limited community surveys indicate there to be high and increasing rates of stroke affecting people at much younger ages in SSA than in developed countries. In general, awareness, diagnosis and management of stroke are poor, and the associated case fatality and residual disability are high. As elsewhere, elevated blood pressure is the major determinant of stroke but there are also high rates of strokes related to the complications of rheumatic heart disease and other infections. Given high attributable risks exposures in association with rapid ageing and urbanisation in SSA, the future is not bright. Population-based incidence studies are urgently needed to map the profile and outcome of stroke. Such data would provide the necessary evidence base to improve prevention and treatments for stroke alongside current efforts to bring infectious diseases under control in SSA.

Recent patterns and predictors of neurological mortality among hospitalized patients in Central Ghana

BACKGROUND

Although neurological disorders are projected to escalate globally in the coming decades, there is a paucity of enumerated data on the burden, spectrum and determinants of outcomes of adult neurological admissions in resource-limited settings, especially within sub-Saharan Africa.

OBJECTIVE

To evaluate the diversity, demography, and determinants of mortality among adult patients presenting with neurological disorders over a 6-year period in a tertiary medical referral institution in the Central belt of Ghana.

METHODS

A retrospective analysis of data on neurological admissions and in-patient outcomes between 2008 and 2013 was undertaken. Data collected for analyses included age, gender, neurological diagnosis, documented comorbidities, duration of admission and vital status at discharge. Predictors of in-patient mortality were evaluated using Kaplan-Meier survival curves and Cox Proportional Hazards regression models.

RESULTS

The 6494 admissions with neurological disorders represented 15.0% of all adult medical admissions over the study period. Male-to-female ratio of admissions was 1.6:1.0 with a mean±SD age of 52.9±20 years. The commonest neurological disorders were Cerebrovascular, Infectious, Seizures/epilepsy, Alcohol-use and Spinal cord disorders representing 54.0%, 26.7%, 10.3%, 4.0% and 2.3% of admissions respectively. Despite the low national HIV prevalence of 2.0%, the frequency of HIV infection among patients with infectious disorders of the nervous system was 40.9%. Overall crude mortality rate for neurologic admissions was 30.6% being 39.1% and 33.9% for Infectious affectations of the nervous system and stroke respectively and 7.4% for seizure disorders. Probability of death was higher for females than males aHR (95% CI) of 1.53 (1.40-1.68) and increasing age aHR (95% CI) of 1.11 (1.06-1.17) for each 20-year increase in age.

CONCLUSION

Almost one in three patients admitted with neurological disease to a tertiary care center in Ghana died in the hospital, and the majority of these deaths were due to non-communicable conditions. Enhanced multi-dimensional public health disease prevention strategies and neurological inpatient care processes are warranted.

Validation of Siriraj Stroke Score in southeast Nigeria

The aim of the study is to validate the use of Siriraj Stroke Score (SSS) in the diagnosis of acute hemorrhagic and acute ischemic stroke in southeast Nigeria. This was a prospective study on validity of SSS in the diagnosis of stroke types in southeast Nigeria. Subjects diagnosed with stroke for whom brain computerized tomography (CT) scan was performed on admission were recruited during the study period. SSS was calculated for each subject, and the SSS diagnosis was compared with brain CT scan-based diagnosis. A total of 2,307 patients were admitted in the hospital medical wards during the study period, of whom 360 (15.6%) were stroke patients and of these, 113 (31.4%) adult subjects met the inclusion criteria. The mean age of the subjects was 66.5±2.6 years. The mean interval between ictus and presentation was 2.5±0.4 days. Ischemic stroke was confirmed by CT in 74 subjects; however, SSS predicted 60 (81.1%) of these subjects correctly (P<0.05). Hemorrhagic stroke was confirmed by CT in 39 subjects, and SSS predicted 36 (92.3%) of them correctly (P<0.05). In acute ischemic stroke, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SSS were 92%, 94%, 97%, 86%, and 93%, respectively, while in patients with hemorrhagic stroke, the corresponding percentages were 94%, 92%, 86%, 97%, and 93%, respectively. SSS is not reliable enough to clinically differentiate stroke types in southeast Nigeria to warrant interventions like thrombolysis in acute ischemic stroke.

The profile of risk factors and in-patient outcomes of stroke in Kumasi, Ghana

BACKGROUND

Stroke is an emerging public health challenge in Ghana requiring urgent attention for its control. Because some of the risk factors for stroke are modifiable, characterisation of these risk factors in the Ghanaian population as well as outcomes of stroke are urgently needed to guide policy for non-communicable diseases. We therefore conducted this study to evaluate the frequencies of the traditional risk factors and outcomes of stroke at the main tertiary referral centre in the middle belt of Ghana in a prospective observational study.

METHODS AND RESULTS

Patients with a clinical diagnosis of stroke were consecutively recruited and vascular risk factors were assessed as well as markers of severity of stroke and in-patient treatment outcomes. 265 patients were recruited, 56.6% were females and mean ± SD age of 64.6 ± 14.54 years. 85%, 73% and 58% of patients had systemic arterial hypertension, physical inactivity and obesity respectively as common risk factors. We identified that patients with stroke had a median of 3 traditional risk factors, were unaware of the presence of these risk factors or were poorly controlled if known. Stroke was associated with a high in-patient case fatality rate of 43% principally among patients with haemorrhagic stroke.

CONCLUSIONS

Our findings indicate that urgent concerted efforts are required to improve public awareness and management of the prevailing risk factors of stroke in Ghana.

[Epidemiological aspects of stroke at emergencies services of Abidjan Heart Institute]

Introduction

L'objectif de notre étude était de décrire les caractéristiques sociodémographiques et les Facteurs de Risque cardio-Vasculaires (FRV) des patients admis pour accidents vasculaires cérébraux (AVC) dans un service autre que celui de la neurologie.

Méthodes

Étude transversale rétrospective sur une période de 2 ans (janv. 2010 et déc. 2011), réalisée aux urgences de l'institut de cardiologie d'Abidjan.

Résultats

Il s'agissait de 176 adultes avec un âge moyen de 60 ans, une prédominance féminine. Les facteurs de risque majeurs retrouvés étaient l'hypertension artérielle dans 86,4% des cas, le diabète dans 11,4% des cas, le tabagisme dans 2,2% des cas. Les motifs de consultation étaient la perte de connaissance dans 36,4% des cas, l'hémiplégie dans 31,8% des cas, les céphalées dans 17,4% des cas, les vertiges dans 10,9% et les palpitations dans 2,2% des cas. La tension artérielle systolique moyenne était à 174 mmHg, la tension artérielle diastolique moyenne était à 105 mmHg et la pression pulsée moyenne était à 70 mmHg. Les AVC étaient associés à une arythmie complète par fibrillation auriculaire dans 11,4% des cas. Les AVC ischémiques représentaient 84,1%. L’évolution aux urgences a été marquée par un décès dans 17% (30) des cas.

Conclusion

Les AVC constituent un problème majeur de santé publique. Malgré sa prédominance féminine, ils (AVC) touchaient 44% des hommes dans notre étude lorsqu'on sait qu'en Afrique l'activité sociale repose sur les hommes. Ils restent une pathologie grave par la forte létalité.

The Clinical Epidemiology of Spontaneous ICH in a Sub-Sahara African Country in the CT Scan Era: A Neurosurgical In-Hospital Cross-Sectional Survey

Background

There is paucity of data-driven scientific reports from sub-Saharan Africa on the burden of spontaneous intracerebral hemorrhage (sICH). We have maintained a prospective consecutive in-hospital database of cases of sICH referred for neurosurgical intervention over a 5-year period.

Methods

This is a cross-sectional descriptive study of the clinical epidemiology and brain computed tomography (CT) characterization of sICH from the database in this region in the current era.

Results

There were 63 subjects, 38 (60.3%) males, aged 28–85 years, mean 55.7 (SD, 12.7), the modal age distribution being the sixth decade. Uncontrolled hypertension was the main predisposition in the study: present, premorbid, in 79%, but uncontrolled in 88% of these known cases, and exhibited malignant derangements of blood pressure in more than half. The clinical ictus to in-hospital presentation was delayed, median 72 h; was in severe clinical state in 70%, 57% was comatose; and was complicated with fever in 57% and respiratory morbidity in 55.6%. The main clinical symptomatology was hemiparesis, headache, vomiting, and aphasia. The sICH was supratentorial on brain CT in 90.5%, ganglionic in 50.8%, and thalamic in 58.3% of the latter. The bleed had CT evidence of mass effect and intraventricular extension (IVH) in more than half. Twenty-three patients (36.5%) underwent operative interventions.

Conclusion

In this patient population, sICH is mainly ganglionic and thalamic in location with significant rate of associated IVH. In-hospital clinical presentation is delayed, and in a critical state, the bleeding is uncontrolled hypertension related in >95%.

Trends in stroke admission and mortality rates from 1983 to 2013 in central Ghana

BACKGROUND

Accumulating data based on model-derived estimates suggest rising rates of stroke in sub-Saharan Africa over the next several decades. Stroke is a leading cause of death, disability, and dementia worldwide. Directly enumerated hospital-based data on the longitudinal trajectory of stroke admissions and deaths in sub-Saharan Africa could help hospital administrators, public health officials, and government policy-makers with planning and utilization of scarce resources.

OBJECTIVE

To evaluate 30-year trends in stroke admission and mortality rates in central Ghana.

METHODS

We undertook a retrospective analysis of data on stroke admissions and mortality at a tertiary referral hospital in central Ghana between 1983 and 2013. Rates of stroke admissions and mortality were expressed as stroke admissions or deaths divided by total number of hospital admissions or deaths respectively. Yearly crude case fatality from stroke was calculated and predictors of stroke mortality were determined using Cox proportional hazards regression analysis.

RESULTS

Over the period, there were 12,233 stroke admissions with equal gender distribution. The rate of stroke admissions increased progressively from 5.32/1000 admissions in 1983 to 13.85/1000 admissions in 2010 corresponding to a 260% rise over the period. Stroke mortality rates also increased from 3.40/1000 deaths to 6.66/1000 deaths over the 30-year period. The average 28-day mortality over the period was 41.1%. Predictors of in-patient mortality were increasing age-aHR of 1.31 (1.16-1.47) for age>80years compared with <40years and admissions in 2000's compared with 1980's; aHR of 1.32 (1.26-1.39). Of the 1132 stroke patients with neuroimaging data: 569 (50.3%) had intracerebral hemorrhage, 382 (33.7%) had ischemic stroke and 181 (16.0) had sub-arachnoid hemorrhage. Patients with ischemic stroke were significantly older than those with ICH and SAH respectively.

CONCLUSION

Rates of stroke admission and mortality have increased steadily over the past three decades in central Ghana. More intensive risk modification and optimization of acute stroke care are urgently needed to stem these worrisome trends.

Epidemiology and in-hospital outcome of stroke in South Ethiopia

INTRODUCTION

Although the burden of stroke in Sub-Saharan Africa, including Ethiopia, is increasing, there are few available data on stroke in Ethiopia.

OBJECTIVE

To describe the magnitude of risk factors, sub-types and in-hospital outcome of stroke at Hawassa University Referral Hospital, Ethiopia.

METHODS

A prospective hospital-based study was conducted with all adult patients admitted to Hawassa University Referral Hospital with stroke diagnosis between May 2013 and April 2014. Computerized tomography scan was performed in all patients to confirm the type of stroke. Stroke severity at admission was assessed by the National Institute of Health Stroke Scale. Stroke outcome at discharge was measured using the modified Rankin stroke scale.

RESULTS

A total of 163 stroke patients were recruited during the study period, of which 82 (50.3%) patients had ischemic stroke while 81 (49.7%) had hemorrhagic stroke. Stroke risk factors included hypertension (50.9%), cardiac diseases (16.6%), diabetes mellitus (7.4%), alcohol (10.4%), cigarette smoking (4.9%) and tuberculous meningitis (3.1%). In-hospital stroke mortality was 14.7%. The main predictors of in-hospital stroke mortality were stroke severity at admission, hemorrhagic stroke, decreased level of consciousness and seizure.

CONCLUSION

The proportion of hemorrhagic stroke is higher than in Western countries. Hypertension is the most common risk factor for stroke. More than half of the patients were discharged with severe disability. We recommend establishing stroke units in resource limited countries like Ethiopia in order to reduce stroke mortality and post stroke disability.

Recent advances in the epidemiology, outcome, and prevention of myocardial infarction and stroke in sub-Saharan Africa

The early part of the new millennium witnessed reports of a growing burden of cardiovascular disease in Sub-Saharan Africa (SSA). However the contribution of ischemic heart disease and stroke to this increasing burden relative to that caused by hypertensive heart disease, cardiomyopathy and rheumatic heart disease was not clear. Over the last decade, data from the continent has begun to clarify this issue and suggests three main points. The burden of ischemic heart disease relative to other causes of heart disease remains low particularly in the black Africans majority. Stroke caused predominantly by hypertension is now a major cause of disability and premature death. Third, the burden of risk factors for atherosclerosis is increasing rapidly in most urban and some rural regions. A concerted effort to understand the primary drivers of this increase in cardiac risk factors is required to prevent a future epidemic of atherosclerosis and its sequelae.

Types, Outcome and Risk Factors of Stroke in Tribal Patients

Introduction

Studies suggest that ethnicity and racial factors has an important role in the variation in epidemiology of stroke. The present study was conducted to assess the subtypes, risk factors, and outcome of stroke in the tribal community of Jharkhand state and to compare it with that in the non-tribals from the same geographical location.

Methods

We carried out a hospital-based prospective observational study at Rajendra Institute of Medical Sciences-Ranchi. Patients of acute stroke, reporting to the medical outpatient department and emergency department from January 1, 2006 to December 31, 2010 were studied. Computed tomography scan was done immediately and again after 24 h to confirm the diagnosis of stroke. To compare the findings between tribal and non-tribal patients, we used chi-square test/Fisher exact test as appropriate.

Results

Of the total 1156 patients included in the study, 536 were tribals, while 620 were non-tribals. Significant differences were found in tribal stroke patients as compared with non-tribals: mean age of tribal subjects was 53·8 years (60·8 years in non-tribals); stroke in young individual was present in 25% of tribal subjects (17% in non-tribals, P = 0·01); primary intracerebral hemorrhage variety was present in 31% of tribals (18% in non-tribals, P-value < 0·001); the 28th day case fatality rate was 43% among tribal subjects (35% among non-tribals, P = 0·02). Hypertension and alcohol abuse was found to be associated with intracerebral hemorrhage in tribal subjects, although no such association was found in non-tribals.

Conclusion

Tribals have early onset, poor outcomes and higher proportion of ICH compared to non-tribals. [Correction added after online publication 7 Aug 2012: The sentence ‘Tribals have early with non-tribals.’ in the Conclusion section of the abstract was deleted.]

Factor VII Activating Protease Polymorphism (G534E) Is Associated with Increased Risk for Stroke and Mortality

Introduction. The FSAP-Marburg I polymorphism (1704G > A), which reduces FSAP activity, is associated with late complications of carotid stenosis in humans. Therefore, this study examines the influence of the Marburg I polymorphism and the closely linked Marburg II polymorphism (1280G > C) on various cardiovascular outcomes in two large independent study populations. Methods. The two Marburg polymorphisms in the HABP2 gene encoding FSAP were genotyped in a large population of elderly patients at risk for vascular disease (the PROSPER-study, n = 5804) and in a study population treated with a percutaneous coronary intervention (the GENDER-study, n = 3104). Results. In the PROSPER study, the Marburg I polymorphism was associated with an increased risk of clinical stroke (HR: 1.60, 95% CI: 1.13-2.28) and all-cause mortality (HR: 1.33, 95% CI: 1.04-1.71). In the GENDER study carriers of this variant seemed at lower risk of developing restenosis (HR: 0.59, 95% CI: 0.34-1.01). The Marburg II polymorphism showed similar but weaker results. Conclusion. The increase in stroke risk in Marburg I carriers could be due to differential effects on smooth muscle cells and on matrix metalloproteinases, thereby influencing plaque stability. The possible protective effect on restenosis could be the result of reduced activation of zymogens, which are involved in hemostasis and matrix remodeling.

Stroke Epidemiology and One-Month Fatality among an Urban Population in Iran

Objective

Stroke is one of the most common causes of death and disability in Iran. This study evaluated stroke patient profiles with respect to rate, risk factors, and one-month fatality.

Material and method

A cross-sectional, hospital-based study on all stroke patients older than 45 years admitted to hospitals in the city of Qom throughout 2001.

Results

Four hundred and sixty patients older than 45 years were admitted as stroke. The annual stroke rate was estimated to 338/100 000 (95% confidence interval, 300–360) inhabitants older than 45 years. The annual rate of stroke was 384/100 000 (95% confidence interval, 381–386) when adjusted to the European population. Stroke subtypes were; ischaemic infarction 75%, intracranial haemorrhage 20·7%, subarachnoid haemorrhage 3%, and undetermined 1·3%. Main risk factors were hypertension in 74·6% and diabetes in 55·7%. Mortality rate was 24·6% within the first month.

Conclusion

Stroke incidence was higher than in Western countries. Hypertension and diabetes mellitus were considerably more frequent in our studied stroke patients than in other developing countries. Our findings need to be addressed in future health education programmes in Iran identifying patients at risk and focusing on more aggressive prevention programmes to lower stroke incidence.

[Management of stroke in sub-Saharan Africa: current issues]

In sub-Saharan Africa, stroke is likely to present an increasingly important public health problem with a larger relative share of overall morbidity and mortality. Overall, sub-Saharan Health Care is characterized by a lack of human resources, lack of facilities for special investigations, and especially an absence of specific programs addressing the prevention of cardiovascular conditions. Current data on the epidemiology of stroke in sub-Saharan Africa, although sparse and fragmentary, indicate a comparatively high incidence of cerebral hemorrhage associated with high blood pressure, while ischemic stroke in black Africans still appears to be related primarily to small artery disease, HIV infection, and sickle cell disease. With urbanization, the role of large-vessel atherosclerosis is increasing. It is thus essential to coordinate government funding, health care professionals and development agencies to address this rising health problem. Access to health care needs to be better structured, and screening programs should be developed in order to identify and treat vascular risk factors. Improved training of health care professionals is also required in the areas of prevention, diagnosis and management of stroke. Implementation of best-practice recommendations for the management of stroke adapted to the specificities and resources of African countries would help rationalize the scarce resources currently available.

Risk factors and treatment of stroke in Chinese young adults

OBJECTIVE

To evaluate the risk factors and treatment status of Chinese stroke patients aged 35-45 years old.

METHODS

We collected data from 1988 in-hospital stroke patients aged 35-45 years old from 36 hospitals in mainland China and compared it to 12,260 health controls with the same age. Information about stroke risk factors was obtained through a questionnaire. Multiple logistic regression and chi-square test were performed to explore the association between risk factors and stroke in young patients.

RESULTS

Of the stroke patients, 94.3% had an ischemic stroke and 73.0% were male. Frequencies of stroke risk factors were significantly higher in patients than those in controls, including history of hypertension (41.0% versus 9.0%, p<0.05), diabetes (5.2% versus 1.7%, p<0.05), hypercholesterolemia (4.2% versus 2.9%, p<0.05), heart diseases (7.2% versus 1.6%, p<0.05), stroke (14.9% versus 1.3%, p<0.05), smoking (38.8% versus 33.3%, p<0.05) and drinking (38.0% versus 24.9%, p<0.05). Furthermore, only 12.8% of patients with hypertension took antihypertensive drugs regularly, and 27.9% of diabetic patients took hypoglycemic drugs regularly. Risk factors when compared between male and female patients were as follows: history of heart diseases (5.9 versus 10.8, p<0.05), smoking (50.9 versus 6.5, p<0.05) and drinking (50.4 versus 5.8, p<0.05).

CONCLUSION

Majority of the Chinese stroke patients aged 35-45 years were male and had suffered an ischemic stroke. The history of stroke, heart disease and hypercholesterolemia could increase the risk of stroke in young adults, and the risk factors in the order of importance were hypertension, smoking, alcohol drinking, previous stroke, heart disease, diabetes mellitus and hyperlipidemia. Hypertension, smoking and alcohol drinking were found to be the main risk factors; treatment state and lifestyle should be improved for young stroke patients.

In-hospital mortality among black patients admitted for hypertension-related disorders in Mbuji Mayi, Congo

BACKGROUND

As a consequence of hypertension, sub-Saharan Africa faces an epidemic of cardiovascular disease.

METHODS

We assessed in-hospital mortality among patients admitted for hypertension-related diseases to two city hospitals in Mbuji Mayi, Congo. On admission, we obtained anthropometric measurements, blood pressure, information on cardiovascular risk factors, and on the awareness and treatment of hypertension. We modeled the probability of death, using stepwise logistic regression.

RESULTS

Of 401 consecutive patients (mean age, 54.3 years; 129 women), 118 (29.4 %) were unaware of their hypertension. Among 283 aware patients (70.6%), 126 (44.5%) were untreated. Systolic/diastolic blood pressure on admission averaged 178/106 mm Hg. In addition to hypertension, 390 patients (97.3%) had other cardiovascular risk factors, including a creatinine clearance below 60 ml/min/1.73 m(2) in 47 subjects (11.7%). Over 15 days (median) of hospitalization, 89 deaths (22.2%) occurred. The multivariable-adjusted probability of death increased with systolic blood pressure (odds ratio (95% confidence interval) for +10 mm Hg, 1.43 (1.15-1.77); P < 0.01), body mass index (+5 kg/m(2), 2.40 (1.39-4.17); P < 0.01), being aware vs. unaware of hypertension (3.17 (1.52-6.61); P < 0.01), and being untreated (2.33 (1.12-4.76); P < 0.05), but it decreased with age (+10 years, 0.65 (0.46-0.92); P < 0.05) and higher creatinine clearance (+10 ml/min/1.73 m(2), 0.71 (0.61-0.82); P < 0.001).

CONCLUSIONS

The in-hospital mortality among African patients hospitalized for hypertension-related disorders in a Congolese provincial capital city is over 20%. These findings underscore that screening and treatment for hypertension and the prevention of cardiovascular disease should be placed much higher on the political agenda in sub-Saharan Africa.

Does Multidisciplinary Stroke Care Improve Outcome in A Secondary-Level Hospital in South Africa?

Background and Purpose

The improved outcome (survival and function) of stroke patients admitted to multidisciplinary stroke units (SU) in developed countries has not been replicated in developing countries in sub-Saharan Africa. This study documents the outcome of patients admitted to the first multidisciplinary SU opened at a secondary hospital in Cape Town, South Africa.

Methods

Patient outcomes including in-hospital mortality, resource utilization (length of hospital stay, CT brain scans performed, and tertiary hospital referral), and access to inpatient rehabilitation were recorded for all patients admitted to the hospital for 3 months before initiating multidisciplinary stroke care and for 3 months after implementing multidisciplinary stroke care.

Results

One hundred and ninety-five patients were studied; 101 of these were managed in the SU. Inpatient mortality decreased from 33% to 16% after initiating multidisciplinary stroke care ( P = 0·005). The length of hospital stay increased from a mean (SD, 95% CI) of 5·1 (6·5, 3·8–6·4) days to 6·8 (4·5, 5·9–7·6) days ( P = 0·01). Referral to inpatient rehabilitation increased from 5% to 19% ( P = 0·04) for those who survived to discharge. The number of CT brain scans performed and the number of referrals to the tertiary academic hospital did not increase significantly.

Conclusions

Multidisciplinary stroke care was successfully implemented in a resource-constrained secondary-level hospital in South Africa and despite the limitations of the study, the significant reduction in inpatient mortality and increase in referral for inpatient rehabilitation would suggest an improvement in stroke care. Resource utilization in terms of length of hospital stay increased by a mean of 2 days but the number of CT brain scans performed and referral to a tertiary hospital did not increase significantly.

The epidemiology of stroke in northern palestine: a 1-year, hospital-based study

BACKGROUND

Although stroke is one of the leading causes of morbidity and mortality worldwide, no studies on stroke were reported from Palestine. The objective of this study was to identify the risk factors and incidence rates of stroke in a well-defined area in north Palestine (i.e., the district of Nablus) with 362,159 native Palestinian inhabitants.

METHODS

All patients admitted to Al-Watani governmental hospital from September 2006 to August 2007 and given the diagnosis of acute stroke were included in the study. Diagnosis of stroke was confirmed by computerized tomography scan. Demographic characteristics and clinical data pertaining to the patients were obtained from their medical files.

RESULTS

A total of 186 patients with stroke (95 female and 91 male) were identified during the study. The average age of the patients was 69.09 +/- 10.9 years. Among the total patients, 112 had a first-ever stroke (FES) and 74 had recurrent stroke (RS). Hypertension, diabetes mellitus, and renal dysfunction were the most common risk factors with comparable prevalence in both FES and RS. The majority of patients (153; 82.3%) had ischemic stroke subtype whereas 33 (17.7%) had hemorrhagic stroke subtype. The overall (FES + RS) annual crude incidence rate of stroke was 51.4 per 100,000 persons whereas the annual crude incidence rate of FES was 31 per 100,000 persons. The age-adjusted incidence rates were 54.5 (FES) and 89.8 (FES and RS). The overall inhospital mortality was 21% and was higher in patients with RS than in those with FES.

CONCLUSION

Modifiable risk factors were common among patients with stroke. Better control of these risk factors might decrease incidence of stroke and all consequences thereafter. Incidence rate and inhospital mortality of stroke reported in this study were within the range reported from other Arab countries.

Lymphotoxin-alpha C804A polymorphism is a risk factor for stroke. The PROSPER study

Inflammation plays a prominent role in the development of atherosclerosis, which is the most important risk factor for vascular events. Lymphotoxin-alpha (LTA) is a pro-inflammatory cytokine and is found to be expressed in atherosclerotic lesions. We investigated the association between the C804A polymorphism within the LTA gene and coronary and cerebrovascular events in 5804 participants of the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). The primary endpoint was the combined endpoint of death from coronary heart disease, non-fatal myocardial infarction, and clinical stroke. Secondary endpoints were the coronary and cerebrovascular components separately. All associations were assessed with a Cox-proportional hazards model adjusted for sex, age, pravastatin use, and country. Our overall analysis showed a significant association between the C804A polymorphism and the primary endpoint (p = 0.03). After stratification for gender, this association was found only in males. Furthermore, we found that the association between the C804A polymorphism and the primary endpoint was mainly attributable to clinical strokes (p = 0.02). The C804A polymorphism in the LTA gene associates with clinical stroke, especially in men. But further research is warranted to confirm our results.

Stroke in Qatar: a first prospective hospital-based study of acute stroke

BACKGROUND

Stroke is a major cause of morbidity and mortality in Qatar.

OBJECTIVES

The aim of our study was to determine types of strokes, the associated risk factors, clinical presentation, outcome, and time to hospital admission among Qatari and non-Qatari patients as well as young and nonyoung patients.

METHODS

We conducted a hospital-based prospective observational study including all patients admitted to Hamad Medical Corporation with first-ever stroke from September 15, 2004, to September 14, 2005. A stroke was defined according to World Health Organization criteria.

RESULTS

Stroke was confirmed in 270 patients of whom 217 (80.4%) had ischemic stroke and 53 (19.6%) had hemorrhagic stroke. Male patients predominated in all types of stroke. The main risk factors for stroke were hypertension and diabetes, whereas lacunar infarct was the most common subtype of ischemic stroke. Risk factor profiles were similar between Qatari and non-Qatari patients except for hypercholesterolemia, which was observed with a higher frequency in Qatari compared with non-Qatari patients with ischemic stroke. There were significant differences between the young and nonyoung patients with ischemic stroke with respect to risk factors, ejection fraction, ventricular wall-motion abnormalities, time to hospital admission, and outcome. Most patients arrived at the hospital more than 3 hours from stroke onset because of unawareness of stroke symptoms. The overall in-hospital mortality was 9.3%.

CONCLUSIONS

Hypertension and diabetes mellitus were the main risk factors for stroke in Qatar, whereas lacunar infarct was the most common subtype. Significant differences between the young and nonyoung patients were observed with respect to risk factors, ejection fraction, ventricular wall-motion abnormalities, time to hospital admission, and outcome.

[Survival of comatose stroke victims in a neurological department in Dakar]

BACKGROUND

In Dakar, stroke is the most frequent neurological disease with the highest mortality. Victims may present in a critical state of coma. The objective of this study was to evaluate survival among comatose stroke patients in Dakar, Senegal.

METHODS

This was a longitudinal prospective study from April 2006 to July 2007 conducted in the Neurological Intensive Care Unit (NICU) of Fann University Teaching Hospital in Senegal. Were included in the study, all stroke patients confirmed by CT scan with a Glasgow coma score less than or equal to 8/15. Patients with subarachnoid hemorrhage were excluded.

RESULTS

A total of 105 patients were evaluated with 54 cases of ischemic stroke among them. The mean age was 61.87+/-14.16 years. The mean duration of hospital stay in the NICU was 10.82+/-11 days with an estimated mortality of 82.9%; the three-month survival was 9.52%. The median overall survival was 7+/-1 days (CI(95%): 5-9).

CONCLUSION

Comatose stroke patients have a poor prognosis, emphasizing the crucial importance of primary prevention.

Frequency of stroke types at an emergency hospital in Natal, Brazil

We performed a cross-sectional study of stroke type frequency at a local emergency hospital, in Natal, Brazil. The sample consisted of all patients who were admitted to an emergency hospital with a presumptive diagnosis of stroke. Of the 416 patients, 328 were studied, 88 were excluded for not meeting inclusion criteria, 74.7% (n= 245) had ischemic stroke 17.7% (n=58) had intracerebral hemorrhage, 7.6% (n=25) had subarachnoid hemorrhage; 173 were men (52.7%). Mean age was 64.1 years. The intrahospital mortality rate was 10.2%, 17.2% and 36% for ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage, respectively. The most prevalent modifiable risk factor was hypertension for ischemic stroke (67.6%) and hemorrhage stroke (57.8%). Logistic regression analysis identified diabetes (OR=3.70; CI=1.76-7.77) as independent risk factor for ischemic stroke. The ischemic stroke was most common type of stroke. Hypertension and diabetes were important risk factors for stroke.