Dissections of cervicocephalic arteries are the main cause of stroke among the young adults. We report the case of a hypertensive and migrainous patient aged 59-years presenting with migrainous cephalea with flashes of light in his left eye and paroxysmal regressive paresthesia of the right hemicorpus. Clinical examination showed apraxia of speech associated with phonemic paraphasia. MRI of cerebral vascular territories with diffusion weighted imaging showed perivascular hyper-intense signal of the left internal carotid artery (intra-petrous portion) and T2 hyposignal suggesting hematoma in the wall with arterial occlusion at this level. MRI with diffusion and flair weighted imaging showed several ponctiform hyperintense signals at the level of the left anterior cerebral arterial territory and junctional hyperintense signals between the anterior cerebral artery and the middle cerebral artery without microbleeds at the level of the parenchyma, suggesting embolic stroke due to carotid dissection. The patient underwent curative Vitamin K antagonist anticoagulation treatment (target INR range of 2 to 3) after heparinotherapy with language therapy. At the three-month follow-up, angio MRI of the supra aortic trunk showed left intrapetrous internal carotid revascularization. Imaging plays an important role in the diagnostic confirmation of the dissections of cervicocephalic arteries and of possible stroke as well as in the immediate management and follow-up of patients.
Subarachnoid hemorrhage is defined as a sudden irruption of blood in subarachnoid spaces. This study aims to determine the profile and in-hospital evolution of patients with post aneurysmal subarachnoid hemorrhage, who did not have surgical treatment in the Neurology Unit of Befelatanana University Hospital, Antananarivo, Madagascar. This study was a descriptive retrospective study within a period of 4 years, from January 1st, 2014 to December 31th, 2017. The study was carried out in hospitalized patients for subarachnoid hemorrhage with aneurysmal origin. We included 52 patients, with an average age of 48 years and a female predominance. They are housewives in majority of cases. 52% of the cases live in urban areas while 77% of cases have high blood pressure. The main clinical manifestation was a sudden headache, and intracranial aneurysm was located at the anterior communicating artery in 52% of cases. All patients benefited from drug treatments in majority of cases. Due to the lack of financial means, 60% had neurological complications. However, in-hospital mortality rate was at 13%. This study helps us to suggest to our patients medical treatment of their subarachnoid hemorrhage during hospitalization because of difficult access to surgery. It also aims to propose surgery outside the acute phase of the disease.
Introduction: Hemorrhagic stroke can be seen in 90% of cases with high blood pressure. It is a predictor of intra-hospital mortality. Our goal is to compare the mortality rate based on admission under our therapeutic strategy for HTA in the acute phase of stroke. Method: A retrospective descriptive, cross-sectional study of consecutive patients was conducted over a 12-month period during the year 2017. Results: We had 20% (3/15) mortality rate in acute phase in those with systolic blood pressure (SBP) in admission at ≥ 180 mmHg (group II) and no death (0/17) was recorded in the those with SBP in admission at 140-179mmHg (group I). A SBP at the 7th day (D7) less than 140 mmHg was not rich in those two groups: 35.29 % in group I (n=6) and 46.66 % in group II (n=7) respectively. The sex ratio was 1. High blood pressure remains the main cardio-vascular risk factor reported in our study (81.21%). All our patients had Glasgow scale value between 13-15 and only the NIHSS value > 10 was associated with high blood pressure in acute phase (p=0.0131). Brain CT Scan was realised in majority of cases at the second day (D2) of stroke (n=16). This, however, is with localisation preference in the basal ganglia, with intra-cerebral hemmorhage (ICH) scale at 1 in 65.62% (n=21) of cases. Conclusion: Intra-hospital mortality in acute phase of hemorrhagic stroke remains high. Instauration of stroke field in Madagascar is necessary and this gives the Befelatanana University Hospital a Neuro- Vascular Intensive Care Unit too.
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