Introduction: Hemorrhagic strokes in the elderly constitute a diagnostic and
therapeutic emergency and, by their frequency and severity, determine a public
health problem. Goal of the Study: To elucidate knowledge and make our
contribution to the study of this pathology (describe the epidemioclinical and
evolutionary aspects of hemorrhagic cerebrovascular accidents in adults in
Bangui). Methodology: It was a retrospective study with descriptive and
analytical aims covering a period of two years (2) from January 2017 to December
2018, conducted in the Neurology department of the Sino-Central
African Friendship University Hospital. Results: During the study, 255 patients
were hospitalized for stroke, including 20 cases of AVCH, representing
a hospital frequency of 7.8%. The average age was 60.05 years with extremes
ranging from 50 to 78 years. The most represented age group was that of 50
to 60 years with a sex-ratio (M/F) of 1.2. Civil servants were more represented
(35%) followed by housewives (25%). Alcohol was the main risk factor (95%)
followed by hypertension (80%) and tobacco (40%). Most of the patients
(75%) were admitted to the care facilities before 6 am (75%). Lethality was
35%. There was a significant statistical link between the Glasgow score and
death (p = 0.007). In this series, 75% of the cases had sequelae dominated by
hemiparesis (75%) and aphasia (25%). Conclusion: First study in the Central
African Republic, with a high frequency, shows that the AVCH of the elderly
poses a public health problem. Requires great mass awareness in order to reduce
its mortality rate.
References
[1]
Béjot, Y., Touzé, E., Jacquin, A., Giroud, M. and Mas, J.L. (2009) Epidemiology of Stroke. MedSci, 25, 727-732. https://doi.org/10.1051/medsci/2009258-9727
[2]
Hankey, G.J. and Warlow, C. (1999) Treatment and Second Prevention of Stroke: Evidence, Cost and Effect on Indiduals and Population. The Lancet, 354, 1457-1463. https://doi.org/10.1016/S0140-6736(99)04407-4
[3]
Sagui, E. (2007) Les accidents vasculaires cérébraux en Afrique Sub saharienne. Médecine Tropicale, 67, 596-600.
[4]
Yao, K.H., Sanogo, S., Binan, A., Hue Lou, A. and Diallo, A.D. (2011) Hypertension artérielle de novo compliqué de l’adulte au milieu hospitalier noir africain. Revue Internationale des Sciences Médicales, 13, 33-36.
[5]
Rancurel, G. and Manai, R. (2005) Les accidents ischémiques transitoires du sujet agé: Nouvelle définition et difficultés du diagnostic. Psychologies & Neuropsychiatries du Vieillissement, 3, 17-26.
[6]
Béjot, Y., Rouaud, O., Gentil, A., Caillier, M., Manckoundia. P., Pfitzenmeyer, P., Ossuby, G.V., Moreau, T. and Giroud, M. (2008) Les accidents vasculaires cérébraux du sujet agé: Ce que nous a appris d’épidémiologie du sujet jeune. Revue Neurologique, 164, 809-814. https://doi.org/10.1016/j.neurol.2008.07.015
[7]
Dabilgou, A.A., Adeline Kyelem, J.M., Dravé, A. and Nikièma Tanguy, M.I. (2018) Les accidents vasculaires cérébraux chez le sujet agé en milieu tropical: Aspects épidemiologiques, cliniques et facteurs pronostiques. Neurologie-Psychiatrie-Gériatrie, 18, 133-139. https://doi.org/10.1016/j.npg.2018.01.002
[8]
Mbelesso, P., Tabo, A., Seboulo, P.C., Yangatimbi, E., Kette, C.G. and Senekian, V.P. (2007) Aspects épidémiologiques des accidents vasculaires cérébraux à l’hôpital de l’Amitié à Bangui en RCA. Benin Medical, 44, 44-46.
[9]
Qureshi, A.I., Tuhrim, S., Brederick, J.P., Batier, H. and Hideki, D. (2001) Spontaneous Intracerebral Hemorrhage. The New England Journal of Medicine, 344, 1450-1460. https://doi.org/10.1056/NEJM200105103441907
[10]
Touré, K., Thiam, A., Sène Diouf, F., Ndiaye, M., Coumé, M., Seck, L.B., Diagne, N.S., Diop, M.S., et al. (2008) Epidemiology of Stroke at the Clinic of Neurology, Fann University Teaching Hospital. Dakar Medical, 53, 105-110.
[11]
Raveloson, N.E., Zodaly, N., Rakoto Arivony, S.T., Mbolamena, R.L. and Randriamiarana, J.M. (2011) Aspects épidemiocliniques, évolutifs et tomodensimetriques des accidents vasculaires cérébraux hémorragiques (34). Revue d’Anesthésie-Réanimation et de Médecine d’Urgence, 3, 15-19.
[12]
Wu, D., Gu, Z.W., Song, D.G., Liu, J.S., Gang, Z. and Tu, C.J. (2018) Développement et validation des modèles de pronostic d'hémorragie intracérébrale hypertensive. Médecine (Baltimore), 97, e12446. https://doi.org/10.1097/MD.0000000000012446
[13]
Bandzouzi, P.E., Adjaratou, D.S., Dadoli, S.L.M., Ndiaye, M., Diop, A.G. and Ndiaye, M.M. (2016) Aspects épidemiocliniques, évolutifs et paraclinique de l’accident vasculaire cérébral du sujet agé. Revue Neurologique, 172, A72. https://doi.org/10.1016/j.neurol.2016.01.171
[14]
Zia, E., Hedbad, B., Pessah-Rasmen, H., Bergland, G., Janzon, L. and Engstrom, G. (2007) Blood Pressure in Relation to the Incidence of Cerebral Infraction and Intracerebral Hemorrhage. Hupertensive Haemorrhage: Debated Nomenclature Is Still Relevant. Stroke, 38, 2681-2685. https://doi.org/10.1161/STROKEAHA.106.479725
[15]
Grillo, P., Velly, L. and Bruder, N. (2006) Accident vasculaire cérébrale hémorragique: nouveautés sur la prise en charge. Annales Françaises d’Anesthésie et de Réanimation, 25, 868-873. https://doi.org/10.1016/j.annfar.2006.03.030
[16]
Honnart, D. and Fournier, C. (2007) AVC hémorragique: Etiologie, critères de gravité et de pronostic. Urgences, 267-278.
[17]
Radak, Z., Kumagai, S. and Taylor, A.W. (2007) Effects of Exercise on Brain Function: Role of Free Radicals. Applied Physiology, Nutrition, and Metabolism, 947-953.
[18]
Davis, S.M., Broderick, J., Hennerici, M., Brun, N.C., Diringer, M.N. and Mayer, S.A. (2006) Hematoma Growth Is a Determinant of Mortality and Poor Outcome after Intracerebral Hemorrhage. Neurology, 66, 1175-1181. https://doi.org/10.1212/01.wnl.0000208408.98482.99
[19]
Gill, J.S., Shipley, M.J., Tsementzis, S.A., Homby, R.S., Gill, S.K. and Hitchcock, E.R. (1991) Alcohol Consumption—A Risk Factor for Hemorrhagic and Non-Hemorrhagic Stroke. The American Journal of Medicine, 90, 489-497. https://doi.org/10.1016/0002-9343(91)90610-A
[20]
Ohwakik, K., Yana, E., Nagashima, H., Hirata, M., Nakagoni, T. and Tomura, A. (2004) Blood Pressure Management in Acute Intracerebral Hemorrhage: Relationship between Elevated Blood Pressure and Hematoma Enlargement. Stroke, 35, 1364-1367. https://doi.org/10.1161/01.STR.0000128795.38283.4b
[21]
Leira, R., Dovalos, A., Silva, V., Ge-Penala, A., Tejada, J. and Gracia, M. (2004) Early Neurologic Deterioration in Intracerebral Hemorrhage: Predictors and Associated Factors. Neurology, 63, 461-467. https://doi.org/10.1212/01.WNL.0000133204.81153.AC
[22]
Dieynabou Sow, A. and Touré, K. (2016) Pronostic des hémorragies cérébrales spontanées du sujet de moins de 55 ans, dans un pays en développement d’Afrique de l’Ouest Exemple du Sénégal, à propos de cinquante-trois cas. Médecine et Santé Tropicales, 26, 170-174.
[23]
Toure, K., Kane, A., Taldia, A., Ndiaye, M.M. and Ndiaye, I.P. (2010) Apport de la tomodensitométrie dans l’épidémiologie des accidents vasculaires cérébraux à l’hôpital général de Grand Yoff. Médecine d’Afrique Noire, 57, 455-460.
[24]
Cowppli-bony, F., Sonan-Douayoma, T., Akani, F., Ahogo, C., N’guessan, K. and Beurgre, E.K. (2007) Epidémiologie des accidents vasculaires hémorragiques au service de Neurologie à Bouaké. Médecine d’Afrique Noire, 54, 199-202.
[25]
Keita, A.D., Touré, M. and Diawara, A. (2005) Aspects épidémiologiques des AVC dans le service de tomodensitométrie à l’hôpital du point G à Bamako, Mali. Médecine Tropicale, 65, 453-457.
[26]
Feigin, V.L., Lawes, C.M., Bennett, D.A. and Anderson, C.S. (2003) Stroke Epidemiology: A Review of Population-Based Studies of Incidence, Prevalence, and Case Fatality in the Late 20th Century. The Lancet Neurology, 2, 43-53. https://doi.org/10.1016/S1474-4422(03)00266-7
[27]
Bogousslavsky, J. (1990) Les accidents vasculaires cérébraux du sujet jeune. Medicine and Hygiene, 48, 2750-2754.
[28]
Ruiz-sandoval, J.L. and Cantu, C. (1999) Intra Cerebral Haemorrhage in Young People: Analysis of Risk Factors, Location, Causes and Prognosis. Stroke, 30, 537-541. https://doi.org/10.1161/01.STR.30.3.537
[29]
Sene-Diouf, F., Mapoure, N.Y. and Ndiaye, M. (2008) Survie des accidents vasculaires cérébraux comateux à Dakar Sénégal. Revue Neurologique, 164, 452-458. https://doi.org/10.1016/j.neurol.2008.01.007
[30]
Leys, D., Hénon, H., Mackowiak-Cordolin, M.A. and Pasquier, F. (2005) Poststroke dementeia. The Lancet Neurology, 4, 752-759. https://doi.org/10.1016/S1474-4422(05)70221-0