Cerebral aneurysms in Africa: A scoping review

Tétinou, Francklin; Kanmounye, Ulrick Sidney; Sadler, Samantha; Nitcheu, Igor; Oriaku, Adaeze Juanita; Ndajiwo, Aliyu Baba; Bankole, Nourou Dine Adeniran

doi:10.1016/j.inat.2021.101291

Cited by 8 publications

(22 citation statements)

References 35 publications

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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%

“…A study in Abuja, Nigeria, [34] reported that across a 4-year period, 57 patients presented with aSAH but only 25 were confirmed to harbor 27 aneurysms while 47% could not afford the cost of confirmation investigations, thus giving an annual A recent scoping review of aneurysmal SAH in Africa revealed the scanty publications on this important subject that dominates neurosurgical literature. [30] Interestingly, most of the publications emanated from North African countries. e publications from sub-Saharan Africa on aneurysms were insignificant in contrast to other neurosurgical topics.…”

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

“…Also, SAH is often misdiagnosed, and most cases remain untreated due to a lack of neuroimaging and limited access to vascular neurosurgeons and neurosurgical facilities in African countries. 102,103 In our study, we could not classify SAH patients into aneurysmal and non-aneurysmal bleeding due to the lack of diagnostic tools in our institute. This fact highlights the limitation of diagnostic tools to identify an aneurysm and the lack of access to interventional neurovascular procedures in low and middle-income African countries compared to high-income countries.…”

Section: Discussionmentioning

confidence: 95%

Clinical Outcomes of Primary Subarachnoid Hemorrhage: An Exploratory Cohort Study from Sudan

Al-Mistarehi

Elsayed

Ibrahim

et al. 2022

The Neurohospitalist

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Background Although Subarachnoid Hemorrhage (SAH) is an emergency condition, its epidemiology and prognosis remain poorly understood in Africa. We aim to explore the clinical presentations, outcomes, and potential mortality predictors of primary SAH patients within 3 weeks of hospitalization in a tertiary hospital in Sudan. Methods We prospectively studied 40 SAH patients over 5 months, with 3 weeks of follow-up for the symptomatology, signs, Glasgow coma scale (GCS), CT scan findings, and outcomes. The fatal outcome group was defined as dying within 3 weeks. Results The mean age was 53.5 years (SD, 6.9; range, 41–65), and 62.5% were women. One-third (30.0%) were smokers, 37.5% were hypertensive, two-thirds (62.5%) had elevated blood pressure on admission, 37.5% had >24 hours delayed presentation, and 15% had missed SAH diagnosis. The most common presenting symptoms were headache and neck pain/stiffness, while seizures were reported in 12.5%. Approximately one-quarter of patients (22.5%) had large-sized Computed Tomography scan hemorrhage, and 40.0% had moderate size. In-hospital mortality rate was 40.0% (16/40); and 87.5% of them passed away within the first week. Compared to survivors, fatal outcome patients had significantly higher rates of smoking (50.0%), hypertension (68.8%), elevated presenting blood pressure (93.8%), delayed diagnosis (56.2%), large hemorrhage (56.2%), lower GCS scores at presentation, and cerebral rebleeding ( P < 0.05 for each). The primary causes of death were the direct effect of the primary hemorrhage (43.8%), rebleeding (31.3%), and delayed cerebral infarction (12.5%). Conclusions SAH is associated with a high in-hospital mortality rate in this cohort of Sudanese SAH patients due to modifiable factors such as delayed diagnosis, hypertension, and smoking. Strategies toward minimizing these factors are recommended.

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“…For instance, a study into cerebral aneurysm failed to highlight aneurysmal location which is an important aspect when choosing a treatment procedure or modality. 3 Furthermore, only 11 of 54 African countries have reported on cerebral aneurysms. 3…”

mentioning

confidence: 99%

“…13 Another example, subarachnoid hemorrhage as a complication of cerebral aneurysm, is frequently misdiagnosed because of a lack of neuroimaging and frequently goes untreated because of a lack of access to vascular neurosurgeons and even neurosurgical facilities. 3 The scarcity of African cerebrovascular surgery data is also a cause for concern because this field of medicine has the potential to broaden the treatment repertoire for severe CVDs. The lack of data stifles the potential benefits that patients may obtain, limiting future advances, because of a lack of understanding of its usage, efficacy, and reach.…”

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confidence: 99%