Incidence and Mortality of Spontaneous Subarachnoid Hemorrhage in Martinique

Abstract

BackgroundIncidence of spontaneous subarachnoid hemorrhages (SAH) varies wildly across the world and seems to be low in Central and South America (4.2 per 100 000 person-years; CI 95%; 3.1–5.7). The objective of our study was to describe the characteristics of SAH and to estimate its incidence and severity in Martinique, a small French island located in the Caribbean Sea.MethodsDue to its insular nature and small captive population, Martinique is ideal for the setting up of population-based epidemiological studies with good exhaustiveness. Our study, spanning a 7 year period (2007–2013), consisted of retrospective case ascertainment with multiple overlapping methods. Crude incidence and 30 day case-fatality rates for SAH among the Martinican population were computed for the study period. Incidence and disease severity was also analyzed according to age, gender and aneurysm presence. World age-standardized incidence rates were also calculated.ResultsA total of 121 patients had a SAH during the study period, with a higher frequency of female cases (71.1% versus 28.9%, p<0.001). Patient mean age was 57.1 years (median = 55 [46–66]). An aneurysmal origin was found in 96 SAH cases (79.3%). Crude annual incidence was 4.36 per 100 000 person-years (CI 95% 2.30–6.42). World age-standardized incidence was 3.29 per 100 000 person-years (CI 95% 1.74–4.84). During the 30 days following SAH diagnosis, 29 patients died (case fatality rate: 24% (CI 95% 16.4–31.6)).ConclusionsThe incidence of spontaneous subarachnoid hemorrhage in Martinique is much lower than in other parts of the world and similar to countries in Central and South America. These results are possibly related to environmental factors and most particularly to a low rate of smoking in the Martinican population. Thirty-day case-fatality rate is similar to what is observed in developed countries.

Spontaneous Subarachnoid Haemorrhage in Neurological Setting in Burkina Faso: Clinical Profile, Causes, and Mortality Risk Factors

“…The mortality rate of SAH was 37.3% in our study, higher than that found in Kashmir (20.38%) [8], in Martinique (24%) [24], and in developed countries [25]. In a previous autopsy study from Kenya, 2.1% of 134 deaths were due to subarachnoid haemorrhage [26].…”

Innate immunity activation in the early brain injury period following subarachnoid hemorrhage

“…Aneurysmal subarachnoid hemorrhage (SAH) is a catastrophic disease associated with significant mortality and morbidity in patients. Approximately 35% of patients will die during the first 30 days following SAH [1]. Unlike other forms of stroke, SAH affects a predominantly young population (40-60 years) [2].…”

“…However, there is a gap in the comprehensive appreciation of the role of inflammation in neuronal cell death after SAH. Our objectives were to characterize the inflammatory-like events (referred to as inflammation from hereon) during EBI and the associated neuronal cell death and motor functions in a mouse model of induced SAH by the following [1]: Measuring the blood cytokine response and leukocyte activation, brain monocytes, neutrophil infiltration, and microglia and astrocytic activation at multiple time points following SAH [2]; assess caspase-3 activation and cell death in neurons; and [3] assess motor function. We also compared measures of the blood cytokine response in our murine model of SAH to blood inflammatory protein profiles in adult patients with SAH in a prospectively enrolled cohort from our critical care unit.…”

Transoceanic Management and Treatment of Aneurysmal Subarachnoid Hemorrhage

“…2,6 This included an 8.8% case fatality for patients transferred to Paris-despite a median delay of 32 hours 13 minutes because of trans-Atlantic transfer. We know that treatment in a high-volume hospital reduces morbidity and mortality.…”

“…W ith a 30-day case fatality rate of around one third, 1,2 aneurysmal subarachnoid hemorrhage (aSAH) is the deadliest type of stroke, even though a decline in mortality rates has been seen over the past 25 years. 3 Furthermore, approximately half of all survivors are left with some neurological deficit, cognitive impairment, or behavioral changes (some of these impairments being likely underestimated with usual assessment scales).…”