Aneurysmal subarachnoid hemorrhage: Geography has a role

Ramachandran, Ramnarayan; Anto, Dominic; Alapatt, Jacob Paul

doi:10.4103/ajns.ajns_301_16

Cited by 4 publications

(10 citation statements)

References 23 publications

(28 reference statements)

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“…A low incidence has been reported from some parts of Asia and Africa. [5,30,11,13,19,22,26,29,[31][32][33] High incidence has been reported from Japan, [8,9] Finland, [10] Greenlandic Eskimos, [15] and in Maoris of New Zealand. [18] Studies such as ours are important and needed to better understand the epidemiologic, clinical, and economic burden of cerebral aneurysms in Africa at national and regional levels.…”

Section: Resultsmentioning

confidence: 99%

“…Autopsy studies have provided information on the incidence of IAs although there may be concerns about the accuracy [29] Ibadan Nigeria 1988-1999 17 1.6 Ohaegbulam [24] Enugu, Nigeria 1974-1977 5 1.7 Ugwuanyi et al [34] Abuja Nigeria 2016-2020 27 6.7 Tokpa et al [33] Abidjan Corte Ivoire 2012-2018 128 18.3 ioub et al [32] Dakar Senegal 2013-2016 129 36.8 Ogenga' o et al [22] Nairobi Kenya 1998-2007 56 6.2 Nabaweesi-Batuka et al [19] Nairobi, Kenya 2010-2014 121 30 El Khamlichi et al [5] Rabat Morocco 1983-1999 200 11.7 Khan et al [12] Quarter 2007-2016 323 32.3 Ramnarayan et al [26] Kozhikode, India 1998-2003 182 36.4 Law et al [16] Hong Kong 2002-2006 135 33.75 van Munster et al [35] Kuopulo Finland 1986-2005 1786 94 van Munster et al [35] Utrecht, Netherlands 1986-2005 1788 94 Korja et al [14] Helsinki, Finland 1995-2009 1993 142.4…”

Section: Does the Study Suggest Low Frequency Of Aneurysms In Enugu?mentioning

confidence: 99%

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Will improved neuroradiology facilities debunk the reported rarity of intracranial aneurysms in Sub-Saharan Africa?

Ohaegbulam

Ndubuisi

Okwunodulu

et al. 2023

Surgical Neurology International

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Background: Intracranial aneurysms (IAN) are rare in the Sub-Saharan Africa unlike other parts of the world. The debate is whether the low frequency might be apparent because of the scarcity of advanced neuroimaging services, or real. This study investigated if improved imaging facilities would debunk the rarity of IAN in our subregion. Methods: This is a retrospective cohort study of prospectively recorded data of patients with subarachnoid hemorrhage (SAH) and IAN managed over 19 years (2003–2021), at the study center with a catchment population of over 47 million. The center witnessed progressive improvements in neuroimaging facilities: 2-Slice, 8-slice, and 64-slice computed tomography (CT) and 0.35T, 1.5T magnetic resonance imaging (MRI) during the period. Results: There were 241 cases of SAH, but only 166 aneurysms were confirmed in 158 patients. Between 2003 and 2008, only 27 IAN patients (4.5 IAN/year) were diagnosed. After introduction of CT angiography/magnetic resonance angiography MRA using 8-slice CT/0.35T magnetic resonance imaging (MRI), between 2009 and 2014, the frequency of IAN increased to 8/year. Between 2015 and 2018 after installation of a 64-slice CT in 2014, the IAN remained the same (8/year). MRI 1.5T was added in 2018, the frequency doubled to 17 cases/year. The females were more (67.7%), the mean age was 46.3 years, but peak incidence was the sixth decade. Internal carotid artery aneurysms including posterior communicating artery were the most common (43%) followed by ACA with anterior communicating artery (24%) and middle cerebral artery (20%). Multiple aneurysms were seen in ten patients. Conclusion: Improved neuroimaging between 2003 and 2021 did not debunk the rarity of IAN in our region.

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Section: Resultsmentioning

confidence: 99%

Section: Does the Study Suggest Low Frequency Of Aneurysms In Enugu?mentioning

confidence: 99%

Will improved neuroradiology facilities debunk the reported rarity of intracranial aneurysms in Sub-Saharan Africa?

Ohaegbulam

Ndubuisi

Okwunodulu

et al. 2023

Surgical Neurology International

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show abstract

“…The female preponderance of SAH in our region is contrary to the previous studies performed in parts of South India, in which males were contributing to the majority of the study population, but our observation is similar to that of the study conducted in North Indian and West African population. 2 3 4 6 The median age of our study population was 55 years. Approximately half of the study population were in their fifth and sixth decades of life.…”

Section: Discussionmentioning

confidence: 99%

“… 1 Indian studies have shown conflicting results about the incidence of aneurysms as the cause of SAH, varying from 35% to 80%, with lesser incidence of aneurysms having been reported in South India previously. 2 3 4 Aneurysmal SAH (aSAH) is often associated with poor outcomes with a mortality rate as high as 50%. 5 The data available on the epidemiology of spontaneous SAH in the South Indian population are very few.…”

Section: Introductionmentioning

confidence: 99%

Clinical Profile and Outcome in Patients with Spontaneous Subarachnoid Hemorrhage from a South Indian Tertiary Centre: A Prospective Observational Study

2023

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Objective Spontaneous subarachnoid hemorrhage (SAH) is a neurological condition that causes significant morbidity and mortality. It is known to have regional differences in its incidence. Indian studies have shown conflicting results about the incidence of aneurysms as the cause of SAH, varying from 35% to 80%. The data available on the epidemiology of spontaneous SAH in the South Indian population are very few. Our study aims to describe the clinical profile of patients presenting with spontaneous SAH to the emergency department in a tertiary center in South India and describe the factors influencing the clinical outcome. Materials and Methods The study included 75 patients diagnosed with spontaneous SAH in our emergency department. Demographic data, medical history, details about the first medical contact, clinical features at admission, complications during the hospital stay, and interventions underwent were recorded. The study participants were followed-up at 6 weeks after discharge from hospital to assess the neurological outcome based on modified Rankin Scale (mRS) score, using a 9-point questionnaire. Results Of the 75 patients with spontaneous SAH, the majority were females, and in the age group of 50 to 69 years. The median time to first medical contact was observed to be 2 hours; and SAH was diagnosed at the first medical contact only in 37% of the patients. Hypertension was the most common comorbid condition associated with SAH (53%). Almost 80% of the patients who underwent angiographic studies had aneurysmal SAH (aSAH). Hydrocephalus was the most common complication seen in 37% of the patients, followed by hyponatremia (28%) and vasospasm (25%). At the time of follow-up after 6 weeks, we found that 36% of the patients were having a neurologically favorable outcome with an mRS score of 0 to 2, 8% of patients were having moderate to severe disability (mRS 3 to 5) and were living a dependent life. The mortality rate (mRS 6) was observed to be around 50% (6% lost to follow-up). Conclusion We observed a relatively higher incidence of aneurysmal rupture among the patients with spontaneous SAH in our region. The misdiagnosis rate at first medical contact was higher. The mortality rate was observed to be around 50% at 6 weeks. Loss of consciousness at ictus, aneurysmal rupture, WFNS grades IV–V, hydrocephalus, vasospasm, hypernatremia, and delayed cerebral ischemia were found to be the mortality predictors in SAH.

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“…In our study, we found a grade II (40%) in the majority, followed by grade I (20%), then grade IV (18%) and finally grade III and V which each had 11%. The study of Ramnarayan et al [21] showed a predominance of grade I (63%), followed by grade II (17%), then grade III (10%), grade IV (6%) and finally grade V (4%). The study by Hayat et al [20] found grade I in 44% of cases, followed by grade III (31%), grade IV (15%) and grade II (10%).…”

Section: World Federation Of Neurological Surgeons (Wfns)mentioning

confidence: 93%

Ruptured Intracranial Aneurysms Operated in Antananarivo: Epidemiology and Prognosis Factors

2023

J Surg

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Introduction: Ruptured intracranial aneurysm is a diagnostic and therapeutic emergency. Surgery remains the only therapeutic option available in Madagascar.Method: This is a retrospective, descriptive and analytical, multicenter study over a period of 4 years (January 2017 to December 2020) in the Neurosurgery Department of the public hospital in Antananarivo. The objective of this study is to determine the epidemic-clinical profile and prognostic factor of ruptured and operated intracranial aneurysm.The regression coefficient or estimation that quantifies the association between the variables was performed, considering a statistical significance threshold of p<0.05Results: 55 patients were included, 19 men and 36 women, aged 30 to 72 years with a mean age of 50 years. The most reported medical history was hypertension (60%), alcoholism (42%), and smoking (33%). The majority of patients (71%) consulted within the first 3 days after the onset of symptoms, for sudden headaches (62%) or consciousness disorders (36%). The clinical examination revealed a Glasgow score of 15 (42%) and 14 (18%). The Hunt and Hess score and the WFNS score were 2 in 44% and 40% of cases respectively. On the brain scan, the Fischer score was 3 in 40% of cases and the aneurysm was in the anterior communicating artery in 45% of cases. None of the patients could benefit from cerebral arteriography due to the unavailability of the latter in the country. Surgery was performed after the 10th day in 34% of cases, and the outcome was favorable in 65% of cases. A mortality rate of 22% was observed. Among the prognostic factors associated with death; we note: Glasgow score less than or equal to 7 (p=0.0001) and Fischer score greater than or equal to 3 (p=0.009). Conclusion:The epidemiological profile of ruptured intracranial aneurysms in our context is superimposable to that of the literature. Access to modern neuroradiology remains limited and underestimates their incidence. Surgical securing of the aneurysm offers a better result despite the rather high death rate.

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Aneurysmal subarachnoid hemorrhage: Geography has a role

Cited by 4 publications

References 23 publications

Will improved neuroradiology facilities debunk the reported rarity of intracranial aneurysms in Sub-Saharan Africa?

Will improved neuroradiology facilities debunk the reported rarity of intracranial aneurysms in Sub-Saharan Africa?

Clinical Profile and Outcome in Patients with Spontaneous Subarachnoid Hemorrhage from a South Indian Tertiary Centre: A Prospective Observational Study

Ruptured Intracranial Aneurysms Operated in Antananarivo: Epidemiology and Prognosis Factors

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