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

Adeleye AO, Osazuwa UA, Ogbole GI - Front Neurol (2015)

Bottom Line: 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.In this patient population, sICH is mainly ganglionic and thalamic in location with significant rate of associated IVH.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Neurological Surgery, College of Medicine, University College Hospital (UCH), University of Ibadan , Ibadan , Nigeria.

ABSTRACT

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%.

No MeSH data available.


Related in: MedlinePlus

A left cerebellar sICH with intraventricular extension. The sagittal reconstruction image shows the hematoma casting the IV ventricle and aqueduct of Sylvius.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4525060&req=5

Figure 2: A left cerebellar sICH with intraventricular extension. The sagittal reconstruction image shows the hematoma casting the IV ventricle and aqueduct of Sylvius.

Mentions: All the 63 cases had brain CT diagnosis of the sICH, but the median time from ictus to acquisition of this imaging was 1 day (range 1–11), or mean 2.67 days (SD, 2.67). Table 3 and Figures 1 and 2 show a spectrum of some of the findings. All had non-trauma-related intracranial bleeding on their CT, 56 (88.9%) of them purely intra-axial. Further analysis revealed no significant associations (chi-square 7.28, p = 0.12) between the different age groups of the study subjects (including those >60 years of age) and the intraparenchymal location of the sICH. The rest was a mixture of intracerebral and extra-axial bleed. Six of these were intracerebral with associated subarachnoid extension (Figure 1A). The ICH was mostly ganglionic in this series and mainly thalamic (Table 3). The hemorrhage was severe in the majority: mean ICH diameter on the CT 50.0 mm (SD, 18.9); median volume (using the ABC/2 rule) was 28.00 ml (range 1–132 ml); there was CT evidence of mass effect (ventricular effacement/midline shift) in 47 cases (78.3%), and ventricular extension of bleed in 41 (65.1%) (Figure 1).


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

Adeleye AO, Osazuwa UA, Ogbole GI - Front Neurol (2015)

A left cerebellar sICH with intraventricular extension. The sagittal reconstruction image shows the hematoma casting the IV ventricle and aqueduct of Sylvius.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4525060&req=5

Figure 2: A left cerebellar sICH with intraventricular extension. The sagittal reconstruction image shows the hematoma casting the IV ventricle and aqueduct of Sylvius.
Mentions: All the 63 cases had brain CT diagnosis of the sICH, but the median time from ictus to acquisition of this imaging was 1 day (range 1–11), or mean 2.67 days (SD, 2.67). Table 3 and Figures 1 and 2 show a spectrum of some of the findings. All had non-trauma-related intracranial bleeding on their CT, 56 (88.9%) of them purely intra-axial. Further analysis revealed no significant associations (chi-square 7.28, p = 0.12) between the different age groups of the study subjects (including those >60 years of age) and the intraparenchymal location of the sICH. The rest was a mixture of intracerebral and extra-axial bleed. Six of these were intracerebral with associated subarachnoid extension (Figure 1A). The ICH was mostly ganglionic in this series and mainly thalamic (Table 3). The hemorrhage was severe in the majority: mean ICH diameter on the CT 50.0 mm (SD, 18.9); median volume (using the ABC/2 rule) was 28.00 ml (range 1–132 ml); there was CT evidence of mass effect (ventricular effacement/midline shift) in 47 cases (78.3%), and ventricular extension of bleed in 41 (65.1%) (Figure 1).

Bottom Line: 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.In this patient population, sICH is mainly ganglionic and thalamic in location with significant rate of associated IVH.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Neurological Surgery, College of Medicine, University College Hospital (UCH), University of Ibadan , Ibadan , Nigeria.

ABSTRACT

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%.

No MeSH data available.


Related in: MedlinePlus