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A Prognostic Challenge of Brainstem Stroke for the Countries of Sub-Saharan Africa: Case of Togo

Received: 26 October 2018    Accepted: 22 January 2019    Published: 18 February 2019
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Abstract

Background and purpose – Brainstem stroke (BSS) is a particular anatomo-clinical variety of strokes. In Sub-Saharan Africa, its epidemiological, therapeutic and prognostic data are rare. The aim of the study was to describe epidemiological aspects and factors associated with the prognosis of BSS in adult patients followed-up at University Hospital Campus of Lomé. A prospective cohort study was carried out from January 1st 2014 to June 30th 2017 (3.5 years) in the department of neurology. It included patients with BSS. Epidemiological characteristics, initial symptoms, brain imaging findings at admission, etiologic factors, therapeutic particularities and outcome measures were assessed. Among the 2,857 patients with stroke, 79 cases of brainstem (2.8%) were diagnosed. Ischemia and hemorrhage were identified in 50 (63.3%) and 29 (36.7%) patients, respectively. Recurrence was observed in 8 patients (10.1%). Hypertension was the main etiological and risk factor. Motor physiotherapy and speech therapy implemented early and associated with other therapies in survivors, had led to the improvement of general state of more than half of the latter. Early mortality and overall mortality were 24 and 31.6%, respectively. Unfavourable prognosis was strongly correlated with diagnosis delay, high blood pressure, deep loss of consciousness, big hematoma volume, presence of encephalic complications and occlusion of basilar arterial trunk. BSS is a less common illness. The main factors identified are associated with an elevated rate of death. Vital prognosis improvement results in factor management and functional rehabilitation.

Published in Clinical Neurology and Neuroscience (Volume 2, Issue 4)
DOI 10.11648/j.cnn.20180204.11
Page(s) 61-67
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Brainstem Stroke, Epidemiology, Clinical Aspects, Prognosis, Lomé

References
[1] Raison JS, Bourbotte G, Baum TP, Pagès M. Hémorragies spontanées du tronc cérébral : étude rétrospective de 25 observations. Rev Neurol 2008 ; 164 : 225 – 232.
[2] Crozier S, Santoli F, Outin H, Aegerter P, Ducrocq X, Bollaert P-E. AVC graves : pronostic, critères d’admission en réanimation et décisions de limitations et arrêt de traitements. Rev Neurol 2011 ; 167: 468 – 473.
[3] Boulogne S, Roggerone S, Deiana G, Derex L, Vukusic S, Confavreux C et al. Infarctus bulbaire paramédian bilatéral d’évolution progressive : A propos de deux cas documentés en imagerie par résonance magnétique séquentielle. Rev Neurol 20 14 ; 170 : 27 – 29.
[4] Diallo M, Guindo M, Mariko O, Kanikomo D, Maïga Y, Diarra OR et al. Apport de la tomodensitométrie dans le diagnostic des hémorragies cérébrales de localisation rare au CHU Gabriel Toure de Bamako (Mali). J Afr Imag Méd 2014; 6 (1): 72 – 78.
[5] Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G. Basilar artery occlusion. Lancet Neurol 2011, 10:1002 –1014.
[6] Thiam A, Ndiaye M, Ndiaye N, Ndiaye IP. Hématome pédonculaire bénin. A propos de deux cas réglés par la tomodensitométrie. Méd Afr Noire 2000; 47: 520 – 524.
[7] Bruder N, Velly L. Accidents ischémiques sous-tentoriels graves. In: Albanese J, Bruder N. Accident vasculaire cérébral et réanimation. Paris, Berlin, Heidelberg, New York: Springer, 2013; 83 – 94.
[8] Schonewille WJ, Wijman CA, Michel P, Rueckert CM, Weimar C, Mattle HP et al. 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 – 730.
[9] WHO. The world health report 2000: health systems improving performance. Geneva: WHO, 2000.
[10] Neau JP, Godenèche G. accidents vasculaires cérébraux. In: Tranchant C, Azulay JP. Neurologie. Paris: Lavoisier-Médecine Sciences Publications, 2012; 332 - 397.
[11] Chung CS, Park CH. Primary pontine hemorrhage: A new CT classification. Neurology 1992; 42: 830 – 834.
[12] Lahlou I, Sekkali N, El Marjani H, El Azzouzi O, Ouaha L, Akoudad H. Le bilan cardiologique d’un accident vasculaire cérébral ischémique. Le journal marocain de cardiologie 2011; 3: 11 – 18.
[13] Hommel M, Besson G. Les syndromes anatomocliniques des infarctus du territoire vertébrobasilaire. Paris : Encycl Med Chir Neurologie, 2006; 17: 046-A35.
[14] Hardie K, Jamrozik K, Hankey GJ, Broad-Hurst RJ, Anderson C. Trends in five-year survival and risk of recurrent stroke after first-ever stroke in the Perth Community stroke Study. Cerebrovasc Dis 2005; 19: 179 – 185.
[15] Valery LF, Krishnamurthi RV. Global urden of stroke. In: Grotta JC, Albers GW, Broderick JP, Kasner SE, Lo EH, Mendelow AD et al.. Stroke: Pathophysiology, diagnosis and management. 6th ed. New York: Elsevier, 2016; 207 – 216.
[16] Béjot Y, Touzé ET, Osseby GV. Epidémiologie descriptive. In : Léger JM, Mas JL. Accidents vasculaires cérébraux. Paris : doin, 2009 ; 103 – 118.
[17] Benatru I, Rouaud O, Durier J, Contegal F, Couvreur G, Bejot Y et al. Stable stroke incidence rates but improved case fatality in Dijon, France, from 1985 to 2004. Stroke 2006; 37: 1674 – 1679.
[18] Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD, et al. Primary prevention of ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the atherosclerotic peripheral vascular disease interdisciplinary working group; cardiovascular nursing council; and the quality of care and outcomes research interdisciplinary working group: the American Academy of neurology affirms the value of this guideline. Stroke 2006; 37: 1583 – 1633.
[19] Howard G, Cushman M, Kissela BM, Kleindorfer DO, McClure LA, Safford MM, et al. Traditional risk factors as the underlying cause of racial disparities in stroke: lessons from the half full (empy?) glass. Stroke 2011; 42: 3369 – 3375.
[20] Wallmann D, Tuller D, Wustmann K, Meier P, Isenegger J, Arnold M et al. Frequent atrial premature beats predict paroxysmal atrial fibrillation in stroke patients: an opportunity for a new diagnostic strategy. Stroke 2007; 38: 2292 – 2294.
[21] Morris JG, Duffis EJ, Fisher M. Cardiac Workup of Ischemic Stroke: Can we improve our Diagnostic Yield? Stroke 2009; 40: 2893 – 2898.
[22] Broderick JP, Adams HP, Barsan W, Feinberg W, Feldmann E, Grotta J et al. Guidelines for the management of spontaneous intracerebral hemorrhage. A statement for healthcare professionals from a special writing group of the stroke council, American Heart Association. Stroke 1999; 30: 905 – 915.
[23] Dziewas R, Kremer M, Lüdemann P, Nabavi DG, Dräger B, Ringelstein B. The prognostic impact of clinical and CT parameters in patients with pontine hemorrhage. Cerebrovasc Dis 2003; 16: 224 – 229.
[24] Savitz SI, Caplan LR, Edlow JA. Pitfalls in the diagnosis of cerebellar infarction. Acad Emerg Med 2007; 14: 63 – 68.
[25] Ois A, Cuadrado-Godia E, Jimenez-Conde J, Gomis M, Rodriguez Campello A, Martinez Rodriguez JE, et al. Early arterial study in the prediction of mortality after acute ischemic stroke. Stroke 2007; 38: 2085 – 2089.
[26] Masiyama S, Niizuma H, Suzuki J. Pontine haemorrhage: a clinical analysis of 26 cases. J Neurol, Neurosurg Psychiatry 1985; 48: 658 – 662.
[27] Jung S, Mono ML, Fisher U, Galimanis A, Findling O, De Marchis GM et al. Three-month and log-term outcomes and their predictors I acute basilar artery occlusion treated with intra-arterial thrombolysis. Stroke 2011; 42: 1946 – 1951.
[28] Louis J, Delgado D, Luis D, Chillet P, Vadot W. Les accidents vasculaires cérébraux du tronc cérébral. In : Société Française de Médecine d’Urgence. Urgences 2009. 3e Congrès de la Société Française de Médecine d’Urgence. Paris, Palais des Congrès de la Porte Maillot, 2009 ; 79 – 89.
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    Josué Euberma Diatewa, Damelan Kombate, Jean-Joël Dongmo, Kossivi Apetse, Komi Assogba, et al. (2019). A Prognostic Challenge of Brainstem Stroke for the Countries of Sub-Saharan Africa: Case of Togo. Clinical Neurology and Neuroscience, 2(4), 61-67. https://doi.org/10.11648/j.cnn.20180204.11

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    ACS Style

    Josué Euberma Diatewa; Damelan Kombate; Jean-Joël Dongmo; Kossivi Apetse; Komi Assogba, et al. A Prognostic Challenge of Brainstem Stroke for the Countries of Sub-Saharan Africa: Case of Togo. Clin. Neurol. Neurosci. 2019, 2(4), 61-67. doi: 10.11648/j.cnn.20180204.11

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    AMA Style

    Josué Euberma Diatewa, Damelan Kombate, Jean-Joël Dongmo, Kossivi Apetse, Komi Assogba, et al. A Prognostic Challenge of Brainstem Stroke for the Countries of Sub-Saharan Africa: Case of Togo. Clin Neurol Neurosci. 2019;2(4):61-67. doi: 10.11648/j.cnn.20180204.11

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  • @article{10.11648/j.cnn.20180204.11,
      author = {Josué Euberma Diatewa and Damelan Kombate and Jean-Joël Dongmo and Kossivi Apetse and Komi Assogba and Agnon Ayélola Koffi Balogou},
      title = {A Prognostic Challenge of Brainstem Stroke for the Countries of Sub-Saharan Africa: Case of Togo},
      journal = {Clinical Neurology and Neuroscience},
      volume = {2},
      number = {4},
      pages = {61-67},
      doi = {10.11648/j.cnn.20180204.11},
      url = {https://doi.org/10.11648/j.cnn.20180204.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cnn.20180204.11},
      abstract = {Background and purpose – Brainstem stroke (BSS) is a particular anatomo-clinical variety of strokes. In Sub-Saharan Africa, its epidemiological, therapeutic and prognostic data are rare. The aim of the study was to describe epidemiological aspects and factors associated with the prognosis of BSS in adult patients followed-up at University Hospital Campus of Lomé. A prospective cohort study was carried out from January 1st 2014 to June 30th 2017 (3.5 years) in the department of neurology. It included patients with BSS. Epidemiological characteristics, initial symptoms, brain imaging findings at admission, etiologic factors, therapeutic particularities and outcome measures were assessed. Among the 2,857 patients with stroke, 79 cases of brainstem (2.8%) were diagnosed. Ischemia and hemorrhage were identified in 50 (63.3%) and 29 (36.7%) patients, respectively. Recurrence was observed in 8 patients (10.1%). Hypertension was the main etiological and risk factor. Motor physiotherapy and speech therapy implemented early and associated with other therapies in survivors, had led to the improvement of general state of more than half of the latter. Early mortality and overall mortality were 24 and 31.6%, respectively. Unfavourable prognosis was strongly correlated with diagnosis delay, high blood pressure, deep loss of consciousness, big hematoma volume, presence of encephalic complications and occlusion of basilar arterial trunk. BSS is a less common illness. The main factors identified are associated with an elevated rate of death. Vital prognosis improvement results in factor management and functional rehabilitation.},
     year = {2019}
    }
    

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    T1  - A Prognostic Challenge of Brainstem Stroke for the Countries of Sub-Saharan Africa: Case of Togo
    AU  - Josué Euberma Diatewa
    AU  - Damelan Kombate
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    PB  - Science Publishing Group
    SN  - 2578-8930
    UR  - https://doi.org/10.11648/j.cnn.20180204.11
    AB  - Background and purpose – Brainstem stroke (BSS) is a particular anatomo-clinical variety of strokes. In Sub-Saharan Africa, its epidemiological, therapeutic and prognostic data are rare. The aim of the study was to describe epidemiological aspects and factors associated with the prognosis of BSS in adult patients followed-up at University Hospital Campus of Lomé. A prospective cohort study was carried out from January 1st 2014 to June 30th 2017 (3.5 years) in the department of neurology. It included patients with BSS. Epidemiological characteristics, initial symptoms, brain imaging findings at admission, etiologic factors, therapeutic particularities and outcome measures were assessed. Among the 2,857 patients with stroke, 79 cases of brainstem (2.8%) were diagnosed. Ischemia and hemorrhage were identified in 50 (63.3%) and 29 (36.7%) patients, respectively. Recurrence was observed in 8 patients (10.1%). Hypertension was the main etiological and risk factor. Motor physiotherapy and speech therapy implemented early and associated with other therapies in survivors, had led to the improvement of general state of more than half of the latter. Early mortality and overall mortality were 24 and 31.6%, respectively. Unfavourable prognosis was strongly correlated with diagnosis delay, high blood pressure, deep loss of consciousness, big hematoma volume, presence of encephalic complications and occlusion of basilar arterial trunk. BSS is a less common illness. The main factors identified are associated with an elevated rate of death. Vital prognosis improvement results in factor management and functional rehabilitation.
    VL  - 2
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Author Information
  • Unit of Neurology, Department of Internal Medicine, Makélékélé Hospital, Marien NGOUABI University, Brazzaville, Congo; Department of Neurology, University Hospital Campus, University of Lomé, Lomé, Togo

  • Department of Neurology, University Hospital Campus, University of Lomé, Lomé, Togo

  • Department of Neurology, University Hospital Campus, University of Lomé, Lomé, Togo

  • Department of Neurology, University Hospital Campus, University of Lomé, Lomé, Togo

  • Department of Neurology, University Hospital Campus, University of Lomé, Lomé, Togo

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