The clinical epidemiology of spontaneous ICH in a sub-Sahara African country in the CT scan era: A neurosurgical in-hospital cross-sectional survey

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%.