An extensive hemispheric lesion and the presence of a mass effect on the brain CT-scan are the two key radiologic parameters associated with a poor outcome in patients admitted for stroke in a tertiary hospital in Bukavu, Democratic Republic of the Congo

Abstract

Introduction: Stroke is a major public health problem in the world. It is the second leading cause of mortality worldwide. The intrahospital mortality for stroke remains higher in African countries compared to the Developed World. Some CT-scan parameters may also have an impact on this prognosis. Some studies have been done in African countries, including in the DRC, on the CT aspects of stroke. But only very few papers focused on the prognosis impact of radiologic findings. This study aimed at determining the radiological factors which impacts the intrahospital mortality of patients admitted to the Provincial General Hospital of Reference of Bukavu (HPGRB) for a stroke and who realized a brain CT-scan.

Materials and Methods: Demographic and radiological data were retrospectively recorded in 52 stroke patients hospitalized at the HPGRB who were able to perform a brain CT-scan between January 2018 and December 2018. The Student's T test was used to compare the averages and the chi-square to compare the proportions. The association between mortality and different prognostic factors was assessed by logistic regression.

Results: Men accounted for 63.5%. Women were significantly younger than men (52.4 ± 14.1 vs 62.0 ± 11.6 years, p <0.05). Ischemic stroke (72.1%) was more frequent than hemorrhage. There was no statistically significant difference between men and women with respect to the different studied CT-scan parameters (p> 0.05). An extensive hemispherical lesion was found in 14% of patients, and a mass effect in 25%. The intra-hospital mortality was 25%, with a significantly higher mortality (p <0.05) in women (42.1%) than in men (15.2%), as well as in the patients under 40 years (75%). In multiple logistic regression, female gender (OR = 10.84), the presence of extensive hemispheric lesion (OR = 14.10) and the presence of a mass effect (OR = 46.24) were independently associated with higher intrahospital mortality (p <0.05).

Conclusion: Mortality after stroke remains relatively high in Bukavu. Patients who present an extensive hemispheric lesion or a mass effect on the brain CT-scan after a stroke should be closely monitored as these factors are associated with a poor prognosis.