Insights in the pathophysiology of haemorrhagic strokes in a sub-Sahara African country, an epidemiological and MRI study

OBJECTIVE

Intra-cerebral Haemorrhage (ICH) seems more prevalent in sub-Saharan Africa (SSA) than in High-Income Countries (HIC) with poorer clinical outcome. Higher impact of hypertension and/or amyloid angiopathy could account for this disproportion. Here, we sought to (i) retrospectively compare ICH clinical and imaging patterns in Belgium and Guinea and in a subsequent cohort (ii) prospectively compare brain MRI characteristics to seek evidence for a different proportion of amyloid angiopathy patterns.

METHODS

Ninety one consecutive patients admitted for spontaneous ICH at Brussels Erasme-ULB Hospital and at Conakry Ignace Deen-UGANC were retrospectively compared in terms of ICH volume estimated with the ABC/2 method, clinical characteristics and modified ranking (mRS) score at 30 days. mRS was dichotomised as good outcomes (≤3) and poor outcomes (>3). A prospective cohort of 30 consecutive patients with ICH admitted at CHU Conakry Ignace Deen-UGANC was prospectively included to undergo brain MRI. Results of the Guinean MRI were compared to 30 patients randomly selected from Brussels' initial cohort. Paired Student's t-test and Mann-Whitney u-test were used for group comparisons.

RESULTS

Age of ICH onset was higher in Belgium (68 ± 17 years vs. 56 ± 14 years, P < 0.01) while ICH volume and 30-day mortality rate were higher in Guinea (20 ml vs. 11 ml, P < 0.01 and mortality 33% vs. 10 %, P < 0.01). ICH burden in survivors in Conakry and Brussels showed respectively good outcomes in 56.7% and 60.4% (P = 0.09) and poor outcomes in 10.3% vs. 29.6% (P < 0.001). MRI analysis of the prospective cohort failed to disclose significant differences regarding brain MRI characteristics.

CONCLUSIONS

Intra-cerebral Haemorrhage affected patients 15 years younger in Guinea with larger haematoma volumes and higher mortality than in Belgium. MRI findings did not show more prevalent amyloid angiopathy pathology suggesting that better primary prevention of hypertension could positively impact ICH epidemiology in Guinea.

[Anatomopathologic, clinical and radiologic aspects of benign tumors of the prostate in Mali, 759 cases]

The benign prostate tumours are dominated by prostatic adenomyoma. They are the first uro-genital pathology worldwide. The objective of this work is to describe the anatomo-pathological, clinical and radiological aspects of benign prostate tumours in Mali. It is a retrospective study which was conducted in Bamako (Mali) form January 1998 to December 2003. It has involved 759 patients who had histological confirmed prostate adenoma in the Department of Urology in Point G University Hospital. The patients were classified according to age, the clinical exam, the rate of prostate specific antigen (PSA), the sonogram, the macro and microscopic exam. The average age of the patients is 75.5 years. The apical part of the prostate is the area mostly involved. The adenomyoma is the most frequent histological type (98% of the cases). A very clear radiological and macroscopic disparity was noticed. "The night pollakiuria" was the primarily clinical sign in all patients; the prostate specific antigen (PSA) is high among more than 80%.