Volume 3, Issue 2, June 2019, Page: 50-57
Mortality and Morbities of Severe Stroke in Limited Ressources Neurological Service
Komi Assogba, Neurology Department, Campus University Teaching Hospital, University of Lomé, Lomé, Togo
Kossivi Apetse, Neurology Department, Campus University Teaching Hospital, University of Lomé, Lomé, Togo
Watouo Marlène Djobosse, Neurology Department, Campus University Teaching Hospital, University of Lomé, Lomé, Togo
Lantam Sonhaye, Neurology Department, Campus University Teaching Hospital, University of Lomé, Lomé, Togo
Nynèvi Anayo, Radiology and Medical Imagery Services, Campus University Teaching Hospital, University of Lomé, Lomé, Togo
Panabalo Waklatsi, Neurology Department, Campus University Teaching Hospital, University of Lomé, Lomé, Togo
Abdoulah Blakime, Neurology Department, Campus University Teaching Hospital, University of Lomé, Lomé, Togo
Victor Kokou Adjenou, Radiology and Medical Imagery Services, Campus University Teaching Hospital, University of Lomé, Lomé, Togo
Koffi Agnon Ayélola Balogou, Neurology Department, Campus University Teaching Hospital, University of Lomé, Lomé, Togo
Received: Feb. 22, 2019;       Accepted: Apr. 9, 2019;       Published: Jun. 29, 2019
DOI: 10.11648/j.cnn.20190302.15      View  29      Downloads  6
Abstract
Introduction: Severe strokes have poor prognosis by their heavy motor and cognitive consequences. Objective: To describe the epidemiological, clinical and therapeutic aspects of these strokes. Material and Method: A retrospective and analytical study was conducted from January 2015 to December 2016 in the neurology department of our University Hospital. The diagnosis of severe stroke was based on clinical criteria (NIHSS score greater than 17, Glasgow score less than 9, and a WFNS stage greater than or equal to IV); and CT scan criteria (stroke location in the posterior fossa, carotid and Sylvian malignant infarction, cerebral hemorrhage with ventricular flood and mass effect). Results: We recorded 1964 strokes and 163 patients had severe stroke with a frequency of 8.3%. Of the 163 severe strokes, ischemic were observed in 38.7% and hemorrhagic for 61.3%. The average age was 55.8 ± 12.8. The motor deficit (76.1%) and disturbances of consciousness (62.6%) were the most admission signs. High blood pressure was the main risk factor (64.8%) and the etiology of hemorrhage in 83.5%. Atherosclerosis was the main etiology (86.4%) of ischemia. The hemorrhagic lesions location was diencephalic (67.7%) and brainstem (21.7%). Overall mortality was 44.8%, including 72.6% of early mortality due to haemorrhage. Predictive factors of mortality were the high NIHSS score, low Glasgow score, presence of ventricular flood, and high volume of hematoma. Conclusion: The high incidence of severe stroke and its early mortality rate demonstrate that many challenges remain to be done to improve the management of patients and avoid disabling sequelae.
Keywords
Epidemiology, Clinical, Severe Stroke, Treatment
To cite this article
Komi Assogba, Kossivi Apetse, Watouo Marlène Djobosse, Lantam Sonhaye, Nynèvi Anayo, Panabalo Waklatsi, Abdoulah Blakime, Victor Kokou Adjenou, Koffi Agnon Ayélola Balogou, Mortality and Morbities of Severe Stroke in Limited Ressources Neurological Service, Clinical Neurology and Neuroscience. Vol. 3, No. 2, 2019, pp. 50-57. doi: 10.11648/j.cnn.20190302.15
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Adams HP, del Zoppo G, Alberts MJ. Guidelines for the early management of adults with ischemic stroke. Stroke 2007; 38: 1655–71.
[2]
Lin DD, Gailloud P, Beauchamp NJ. Combined stent placement and thrombolysis in acute vertebrobasilar ischemic stroke. Am J Neuroradiol 2003; 24: 1827–33.
[3]
Frankel MR, Morgenstern LB, Kwiatkowski T. Predicting prognosis after stroke: a placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial. Neurology 2000; 55: 952–9.
[4]
Broderick JP, Adams HP, Barsan W. Guidelines for management of spontaneous intracerebral hemorrhage. Stroke 1999; 30: 905-15.
[5]
Schwamm LH, Pancioli A, Acker JE, Goldstein LB, Zorowitz RD, Shephard TJ, et al. Recommendations for the establishment of stroke systems of care: recommendations from the American Stroke Association’s Task Force on the Development of Stroke Systems. Circulation 2005; 111: 1078–91.
[6]
Manjila S, Masri T, Shams T, Chowdhry SA, Sila C, Selman WR. Evidence-based review of primary and secondary ischemic stroke prevention in adults: a neurosurgical perspective. Neurosurg Focus 2011; 30: 125-32.
[7]
Brewer L, Mellon L, Hall P, Dolan E, Horgan F, Shelley E. Secondary prevention after ischaemic stroke: the ASPIRE-S study. BMC Neurology. 2015; 15: 216-21.
[8]
Heuschmann PU, Kircher J, Nowe T, Dittrich R, Reiner Z, Cifkova R, et al. Control of risk factors after ischaemic stroke across Europe: data from the stroke-specific module of the EUROASPIRE III survey. European Journal of Preventive Cardiology. 2015; 22(10): 1354–62.
[9]
Grigoryan M, Chaudhry SA, Hassan AE, Suri FK, Qureshi AI. Neurointerventional procedural volume per hospital in United States: implications for comprehensive stroke center designation. Stroke J Cereb Circ 2012; 43: 1309–14.
[10]
Ding D. Endovascular mechanical thrombectomy for acute ischemic stroke: a new standard of care. J Stroke 2015; 17: 123-9.
[11]
Badhiwala JH, Nassiri F, Alhazzani W, Selim MH, Farrokhyar F, Spears J, et al. Endovascular thrombectomy for acute ischemic stroke: a meta-analysis. JAMA 2015; 314: 1832–43.
[12]
Weshler LR. Imaging evaluation of acute ischemic stroke. Stroke 2011; 42: 12-7.
[13]
Lacy CR, Suh DC, Bueno M, Kostis JB. Delay in presentation and evaluation of acute stroke: Stroke Time Registry for Outcomes Knowledge and Epidemiology (STROKE). Stroke 2001; 32: 63-9.
[14]
Ois A, Cuadrado-Godia E, Jimenez-Conde J. Early arterial study in the prediction of mortality after acute ischemic stroke. Stroke 2007; 38: 2085–9.
[15]
Edlow JA, Newman-Toker DE, Savitz SI. Diagnosis and initial management of cerebellar infarction. Lancet Neurol 2008; 7(10):951– 64.
[16]
Dufour M, Bouafe A, Bruder N. Diagnosis in general hospital and immediate care of patients suffering from severe subarachnoid haemorrhage. Ann Fr. Anesth Reanim 2005; 25: 715-20.
[17]
Jones F, Riasi A, Norris M. Self-management after stroke: time for some more questions. Disabil Rehabil. 2013; 35(3): 257–64.
[18]
Jones F, Mandy A, Partridge C. Changing self-efficacy in individuals following a first time stroke: preliminary study of a novel self-management intervention. Clin Rehabil. 2009; 23(6): 522–33.
[19]
Howard G, Cushman M, Kissela BM. Traditional risk factors as the underlying cause of racial disparities in stroke: lessons from the half full (empty?) glass. Stroke 2011; 42(12): 3369–75.
[20]
Rees L, Marshall S, Hartridge C, Mackie D, Weiser M. Cognitive interventions post acquired brain injury. Brain Inj. 2007; 21(2): 161–200.
[21]
Sene Diouf F, Mapoure NY, Ndiaye M, Ndiaye MM, Sow A, Ndiaye IP. Survival of comatose stroke patients in Dakar (Senegal). Rev Neurol 2008; 68: 606–10.
[22]
Goldstein LB, Adams R, Alberts MJ. Primary prevention of ischemic stroke: Stroke 2006; 37: 1583–92.
[23]
Grotto I, Huerta M, Sharabi Y. Hypertension and socioeconomic status. Curr Opin Cardiol 2008; 23(4): 335–9.
[24]
Freedman KS, Nelson NM, Feldman LL. Smoking initiation among young adults in the United States and Canada, 1998-2010: A systematic review. Prev Chron Dis 2012; 9: 1103-7.
[25]
Mahoungou-Guimbi KC, Ellenga-Mbolla BF, Damba-Banzouzi BY. Hemorrhagic strokes in intensive care unit. Rev. Afr. Anesth. Méd. Urg, 2012; 17(3): 51–5.
[26]
Holloway RG, Benesch CG, Burgin WS. Prognosis and decision making in severe stroke. JAMA 2005; 294: 725–33.
[27]
Crozier S, Santoli F, Outin H, Morini B, Gravio F, Tremoni A, et al. Grave strokes: intensive care unit admission criteria, decision of limitation and stop of treatment and prognostic. Rev Neurol 2011; 167: 468–73.
[28]
Chobanian AV, Bakris GL, Black HR, Cushman WC, Donald CG, Green A, et al. Seventh report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure. Hypertension, 2003; 42: 1206–52.
[29]
Calvet D, Bracard S, Mas J-L. Arterial and veinous cerebral ischemic treatment. Experts formalized recommendations for stroke management by urgentist. Revue Neurol, 2012; 168: 512–21.
[30]
Weir CJ, Bradford AP, Lees KR. The prognostic value of the components of the Glasgow coma scale following acute stroke. QJM 2003; 96: 67-74.
[31]
Boulogne S, Roggerone S, Deiana G, Lemaire G, Cristoli F, Regis A, et al. Bilateral paramedian bulbar infarction of progressive evolution: A study of cases with MRI. Rev Neurol 2014; 170: 277– 9.
[32]
Diallo M, Guindo M, Mariko O. Contribution of the CT scan in the diagnostics of rare cerenral hemorrhagic localisation at Gabriel Toure University Hospital of Bamako (Mali). J Afr Imag Méd 2014; 6(1): 72-8.
[33]
Erro ME, Gallego J, Herrera M, Bermejo B. Isolated pontine infarcts: Etiopathogenic mechanism. Eur J Neurol 2005; 12: 984–8.
[34]
Oppenheim C, Samson Y, Manai R. Prediction of malignant middle cerebral artery infarction by diffusion weighted imaging. Stroke 2000; 31: 2175-81.
[35]
Diagana M, Ould ASB, N’diaye M, Seydou B, Sy L, Sarr B, et al. Impact of cares chain in acute phase of stroke to improve functional outcome in Nouakchott. AJNS 2008; 27: 39-46.
[36]
Jacobi J, Fraser GL, Coursin DB, Riker RR. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002; 30: 119–41.
[37]
Montavont A, Nighoghossian N, Derex L. Intravenous rtPA in vertebrobasilar acute infarcts. Neurology 2004; 62: 1854–6.
[38]
Schonewille WJ, Wijman CA, Michel P. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): A prospective registry study. Lancet Neurol 2009; 8: 724–30.
[39]
Vahedi K, Hofmeijer J, Juettler E. Early decompressive surgery in malignant infarction of the middle cerebral artery: A pooled analysis of three randomized controlled trials. Lancet Neurol 2007; 6: 215–22.
[40]
Jung S, Mono ML, Fisher U. Three-month and log-term outcomes and their predictors I in acute basilar artery occlusion treated with intra-arterial thrombolysis. Stroke 2011; 42: 1946–51.
Browse journals by subject