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Abstract
ABSTRACT
Introduction. Subarachnoid Hemorrhages (SAH) secondary to ruptured aneurysm (RA) are frequent and severe pathologies. Methods. From January 1st 2016 to December 31st 2020, all consecutive spontaneous SAH cases admitted in the teaching hospitals of Yaounde were analyzed. Results. During the study period, 774 stroke cases were registered, including 90 cases of SAH (11.63) with a sex ratio of 1/1.5. The median age was 49 years [range: 17 – 72. The patients were admitted to the internal medicine unit (48), the neurosurgery unit (37) and the intensive care unit (15). The classification was WFNS I (47.9), WFNS II (27.1), WFNS III (10.4), WFNS IV (10.4) and WFNS V (4.2). Positive diagnosis was made by CT scan (85.4), MRI (14.6) and lumbar puncture combined to CT scan (10.4). The delay was 24hrs (33%), 24-48hrs (17), after 72hrs (50); Fischer modified score was Grade I (29.2), Grade II (25), Grade III (22.9). The main etiology found was ruptured aneurysms (76) and arteriovenous malformation (10). Treatment consisted of microsurgical clipping of aneurysms and external CSF diversion; the other patients were treated medically. Conclusion. The high loss of patients from the admission to the neurosurgical consultation of SAH is common in Yaounde. It was due probably to disorientation of the patients, underdiagnosis and lack of endovascular equipment, the reinforcement of knowledge for a better screening and orientation of SAH to the right services and the right specialties in our environment is needed.
RÉSUMÉ
Introduction. Les hémorragies sous-arachnoïdiennes (HSA) secondaires à une rupture d’anévrisme sont des pathologies fréquentes et graves. Méthodes. Du 1er janvier 2016 au 31 décembre 2020, tous les cas spontanés consécutifs d’HSA admis dans les hôpitaux universitaires de Yaoundé ont été analysés. Résultats. Durant cette période, 774 cas d’AVC furent enregistrés, dont 90 cas d’HSA (11, 63 %) avec un sex ratio de 1/1, 5. L’âge médian était de 49 ans [de 17 – 72ans]. Les patients étaient admis en médecine interne (48%), en neurochirurgie (37%) et aux soins intensifs (15%). La classification était WFNS I (47, 9%), WFNS II (27, 1%), WFNS III (10, 4%), WFNS IV (10, 4%) et WFNS V (4, 2%). Un diagnostic positif a été posé par tomodensitométrie (85, 4 %), IRM (14, 6 %) et ponction lombaire combinée à la tomodensitométrie (10, 4 %). Le délai était de 24 heures (33%), de 24-48 heures (17 %) , après 72 heures (50 %); Le score modifié de Fischer était grade I (29,2 %), grade II (25 %) , grade III (22,9 %). L’étiologie principale était une rupture d’anévrismes (76 %) et une malformation artérioveineuse (10 %). Le clippage microchirurgical des anévrysmes et la derivation ventriculaire externe du LCR étaient les principaux traitements, les autres patients étant traités médicalement. Conclusion. La perte élevée de patients de l’admission à la consultation neurochirurgicale de l’HSA est fréquente à Yaoundé . Les raisons probables sont la mauvaise orientation des patients, le retard de diagnostic et l’absence de technologies pour la voie endovasculaire. Le renforcement des connaissances pour un meilleur dépistage et une meilleure orientation de l’HSA vers les bonnes spécialités dans notre environnement est nécessaire.
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References
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- Lafuente, J. and Maurice-Williams, R.S. (2003) Ruptured Intracranial Aneurysms: The Outcome of Surgical Treatment in Experienced Hands in the Period Prior to the Advent of Endovascular Coiling. Journal of Neurology, Neurosurgery & Psychiatry, 74, 1680-1684. https://doi.org/10.1136/jnnp.74.12.1680
- Britz, G.W., Salem, L., Newell, D.W., Eskridge, J. and Flum, D.R. (2004) Impact of Surgical Clipping on Survival in Unruptured and Ruptured Cerebral Aneurysms: A Population-Based Study. Stroke, 35, 1399-1403. https://doi.org/10.1161/01.STR.0000128706.41021.01
- Yao, Z., Hu, X., Ma, L., You, C. and He, M. (2017) Timing of Surgery for Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. International Journal of Surgery, 48, 266-274. https://doi.org/10.1016/j.ijsu.2017.11.033
- Tokpa, A., Haidara, A., Derou, L., Dongo, S., Kakou, M., and Varlet, G. (2020) Microsurgical management of intracranial aneurysms in Cote d’Ivoire: A series of 128 cases.Open Journal of Modern Neurosurgery. 10, 105-113. https://doi.org/10.4236/ojmn.2020.101011
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- https://www.hsd-fmsb.org/index.php/hsd/article/view/2103
References
Krishnamurthi RV, Ikeda T, Feigin VL. Global, Regional and Country-Specific Burden of Ischaemic Stroke, Intracerebral Haemorrhage and Subarachnoid Haemorrhage: A Systematic Analysis of the Global Burden of Disease Study 2017. Neuroepidemiology. 2020;54(Suppl. 2):171‑9.
Masson E. Problématique des hémorragies méningées dans les pays en développement : cas du Togo. EM-Consulte. https://www.em-consulte.com/article/1093034
Akıncı AT, Aktürk Y, Tütüncüler B, Orakdöğen M, Şimşek O. The effects of the early and ultra-early intervention on the outcome in aneurysmatic subarachnoid hemorrhage. Ulus Travma Ve Acil Cerrahi Derg Turk J Trauma Emerg Surg TJTES. juill 2021;27(4):449‑56.
Susan Y, Diana G. Subarachnoid hemorrhage and its medical management. In: Michel T, Torbey and Magdy H, eds.The stroke book. second Edition.Cambridge University Press 2013. https://doi.org/10.1017/CBO9781139344296.015
Molyneux, A.J., Kerr, R., Stratton, I., Sandercock, P., Clarke, M., Shrimpton, J., et al. (2002) International Subarachnoid Aneurysm Trial (ISAT) of Neurosurgical Clipping versus Endovascular Coiling in 2143 Patients with Ruptured Intracranial Aneurysms: A Randomised Trial. TheLancet, 360, 1267-1274. https://doi.org/10.1016/S0140-6736(02)11314-6
Thioub, M., Mbaye, M., Thiam, A.B., Zirhumana, C., Sy, C., Ndoye, N., Ba, M.C. and Badiane, S.B. (2018) Microsurgical Treatment of Ruptured Intracranial Aneurysms in Sub-Saharan Africa: A Series of 102 Consecutive Cases Treated in Senegal. WorldNeurosurgery, 110, 226-231. https://doi.org/10.1016/j.wneu.2017.11.048
Mudjir, B.D., Quenum, K., Boutarbouch, M., Arkha, Y., Derraz, S., El Ouahabi, A., et al. (2006) Les anévrysmes cérébraux ne sont pas rares au Maroc et probablement en Afrique. Notre expérience sur une série de 354 cas [Brain Aneurysms Are Not Uncommon in Morocco and Probably in Africa. Our Experience on a Series of 354 Cases]. Neurochirurgie, 52, 471. https://doi.org/10.1016/S0028-3770(06)71260-7
Lafuente, J. and Maurice-Williams, R.S. (2003) Ruptured Intracranial Aneurysms: The Outcome of Surgical Treatment in Experienced Hands in the Period Prior to the Advent of Endovascular Coiling. Journal of Neurology, Neurosurgery & Psychiatry, 74, 1680-1684. https://doi.org/10.1136/jnnp.74.12.1680
Britz, G.W., Salem, L., Newell, D.W., Eskridge, J. and Flum, D.R. (2004) Impact of Surgical Clipping on Survival in Unruptured and Ruptured Cerebral Aneurysms: A Population-Based Study. Stroke, 35, 1399-1403. https://doi.org/10.1161/01.STR.0000128706.41021.01
Yao, Z., Hu, X., Ma, L., You, C. and He, M. (2017) Timing of Surgery for Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. International Journal of Surgery, 48, 266-274. https://doi.org/10.1016/j.ijsu.2017.11.033
Tokpa, A., Haidara, A., Derou, L., Dongo, S., Kakou, M., and Varlet, G. (2020) Microsurgical management of intracranial aneurysms in Cote d’Ivoire: A series of 128 cases.Open Journal of Modern Neurosurgery. 10, 105-113. https://doi.org/10.4236/ojmn.2020.101011
Figuim, B., Bijevé Moussa, M., Nassourou Oumarou, H., Douanla, A., Mbele Messanga, G., Lékane Tsafack, N.A. and Djientcheu, V. de P. (2020). Syndrome de Terson consécutif à une Hémorragie Sous-Arachnoïdienne chez une patiente de 29 ans. Health Sciences and Diseases, 21(7).