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Management of Spontaneous Intracerebral Haemorrhage (sICH) at the University Hospital of Brazzaville (CONGO)

Neuroscience & Medicine 2024年第1期15卷 23-38页

作者： Ekouele Mbaki Hugues Brieux Ngoma Niangui Léocia Exaucée Diatewa Josué Euberma Boukaka Kala Rel Gerald Ngackosso Olivier Brice Mpandzou Ghislain Armel Boukassa Léon ossou-nguiet paul macaire Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of the Congo Multipurpose Surgery Department University Hospital Center of Brazzaville Brazzaville Republic of the Congo Neurology Department University Hospital Center of Brazzaville Brazzaville Republic of the Congo

Spontaneous intracerebral haemorrhage (sICH) is characterised by bleeding within the brain parenchyma, without any accompanying vascular malformation, parenchymal abnormality or coagulation disorder. The study aimed to depict the management of sICH at the University Hospital of Brazzaville (UHB). It was an observational, descriptive, and cross-sectional analysis. Data collection was conducted retrospectively, covering the period from January 1, 2020 to August 31, 2022, spanning two years and eight months. The study examined socio-demographic, diagnostic, therapeutic, and evolutionary variables. We included 274 cases. We observed 160 men (58.4%) and 114 women (41.6%), resulting in a sex ratio of 1.4. The mean age was 55.3 ± 11.4 years, with ages ranging from 31 to 93 years. The detection of sICH was typically a result of experiencing motor deficits (59.5%) or disorders of consciousness (37.2%). The weightiness of one half of the body was the most common reason for seeking medical advice. Hematoma was capsulo-lenticular in 159 cases (58%) and capsulo-thalamic in 63 cases (23%). Hematomas were 30 ml in 112 cases (40.9%), and associated with hydrocephalus in 11.7% of cases. Conservative medical treatment was administered in 257 cases (94.2%) while surgical treatment was performed in 16 cases (5.8%). The surgical techniques used were external ventricular drainage (EVD) in 2 cases, ventriculo-peritoneal shunt in 5 cases, and hematoma evacuation in 10 cases. Death occurred before the 7th day of hospitalisation in 73 cases (57.8%) and after in 46 cases (42.2%). The median time to death was four days (Q1 = 2 days;Q3 = 7 days), with extremes of 0 and 216 days. .

关键词： Spontaneous Intracerebral haemorrhage Management Brazzaville

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Anterior Cerebral Infarction by Fronto-Basal Meningioma

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Neuroscience & Medicine 2013年第4期4卷 277-289页

作者： paul macaire ossou-nguiet Dieu Donné Gnonlonfoun Karen Obondzo-Aloba Hugues Brieux Ekouélé-Mbaki Gilbert Fabrice Otiobanda Department of Intensive Care University Hospital of Brazzaville Brazzaville Congo Department of Neurology University Hospital of Brazzaville Brazzaville Congo Department of Neurology University Hospital of Cotonou Cotonou Benin

The association between stroke and meningioma is rarely reported in the data. In most etiology classification, there is no compressive cause. The association between meningioma and stroke is increasingly reported. We report a case of 52-year-old woman, previously healthy, presented with sudden right hemiplegia with some transient mood disorders. The CT-scan revealed acute left anterior cerebral artery infarction associated with fronto-basale meningioma infiltrating both anterior cerebral arteries. She was treated by corticosteroid and rehabilitation, with partial recovery. No stroke prevention was used before surgical treatment.

关键词： Infarction Anterior Cerebral Artery Meningioma

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Cost of Stroke Care at Public Hospitals in Brazzaville and Implication of Third Parties in Stroke Care Expenditure

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World Journal of Neuroscience 2022年第2期12卷 82-92页

作者： Josué Euberma Diatewa Ghislain Armel Mpandzou Patrice Bruno Mokoko Dinah Happhia Boubayi Motoula-Latou Eliot Prince Galiéni Sounga-Banzouzi paul macaire ossou-nguiet Neurology Department University Hospital of Brazzaville Brazzaville Congo Faculty of Health Sciences Marien Ngouabi University Brazzaville Congo Neurology Department Loandjili General Hospital Pointe Noire Congo

Background: Among the main challenges of healthcare system throughout the world, there is stroke management. It is important to have data on the in-hospital costs of stroke care to help decision-makers to implement a health insurance system. Objectives: To evaluate the in-hospital costs of stroke care in Brazzaville;to determine the factors influencing the total mean in-hospital cost of stroke care;to identify third parties contributing to stroke care expenditure. Methods: This was a cross-sectional prospective and analytical study. It was carried out at 4 public hospitals in Brazzaville (University Hospital Center, Chinese and Congolese Friendship Hospital, Talangaï Hospital and Makélékélé Hospital), from May to August 2019 (4 months). It focused on patients who had a first episode of stroke confirmed by brain imaging and were at least 18 years old. The bottom-up approach was used to determine the in-hospital costs of stroke care. Results: This study included 109 patients who fulfilled inclusion criteria. Their mean age was 59.2 ± 13.7 years old, with limits of 35 and 90 years old. The total direct in-hospital cost of stroke care was 47,308,330 francs CFA (72,122 euro). The total mean in-hospital cost of stroke care was 1,389,590 francs CFA (2118 euro). The mean cost of intracerebral hemorrhage care was 510,988 francs CFA (779 euro) versus 373,457 francs CFA (569 euro) for cerebral arterial infarction care. The following factors affected the total mean cost of stroke care: type of hospital (p < 0.0001), length of hospital stay (p = 0.001), type of stroke (p = 0.01), stroke severity (p = 0.001) and complications (p = 0.001). The level of contribution to stroke care expenditure covered by third parties was: 78% for patient families;2.8% for community self-help associations. Conclusion: In Congo, the mean in-hospital cost of stroke care is elevated considering the guaranteed minimum wage of 70,000 francs CFA (107 euro). Five factors affect the total mean cost of

关键词： Stroke Hospital Cost Associated Factors Brazzaville

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Hypertension and intracerebral hemorrhage in Brazzaville

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World Journal of Cardiovascular Diseases 2013年第9期3卷 523-528页

作者： Thierry Raoul Gombet paul macaire ossou-nguiet Thibaut Naibe Gankama Bertrand Fikahem Ellenga-Mbolla Gilbert Fabrice Otiobanda Karen Obondzo-Aloba Benjamin Longo-Mbenza Department of Medicine Faculty of Health Sciences of Brazzaville Brazzaville Congo Service of Emergency University Hospital of Brazzaville Brazzaville Congo Department of Medicine Faculty of Health Sciences of Brazzaville Brazzaville CongoService of Cardiology University Hospital of Brazzaville Brazzaville Congo Department of Medicine Faculty of Health Sciences of Brazzaville Brazzaville CongoService of Neurology University Hospital of Brazzaville Brazzaville Congo Faculty of Health Sciences Walter Sisulu University Mthatha South Africa Service of Cardiology University Hospital of Brazzaville Brazzaville Congo Service of Neurology University Hospital of Brazzaville Brazzaville Congo Service of Reanimation University Hospital of Brazzaville Brazzaville Congo

Hypertension is not only an important risk factor, but also an important cause of spontaneous intracerebral hemorrhage. Its high prevalence in Africa reflects a high incidence of cerebral hemorrhage ranging from 30% to 60% against 10% to 20% in industrialized countries. The aim of our study was to determine the role of hypertension before the onset of intracerebral hemorrhage and its variations during the first three months. This was a longitudinal study conducted at the University Hospital of Brazzaville from 1st January to 31st August 2012 with all patients admitted for intracerebral hemorrhage. Patients with subarachnoid or pure intraventricular hemorrhage were excluded. The study variables were: history of hypertension, knowledge of its history, treatment, blood pressure on admission and during the first 3 months and the relationship between blood pressure and evolution. Statistical analysis was performed using the software SPSSS 16.1. The significance level was set at p < 0.05. During the study 261 patients were hospitalized for stroke, of which 82 (31.42%) were for intracerebral hemorrhage. The mean age was 55 ± 11 years and sex ratio of 2 men:1 woman. Hypertension was found in 80.5% of cases, of which 65.2% had known hypertension, but 82.6% had discontinued treatment. The mean systolic blood pressure was 194 ± 41 mm Hg and diastolic 104 ± 20 mm Hg. The location was deep in 85.71%. The normalization of blood pressure was obtained from the second week. After adjusting for confounders using logistic analysis, only uncontrolled hypertension was associated significantly and independently associated with a higher mortality rate (p = 0.042).

关键词： Hypertension Cerebral Hemorrhage Brazzaville

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Post-Stroke Cognitive Disorders and Associated Factors in French Speaking West Africa, Benin Case

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Neuroscience & Medicine 2014年第1期5卷 32-41页

作者： Dieu Donné Gnonlonfoun paul macaire ossou-nguiet Lansana Laho Diallo Constant Adjien Isaac Avlessi Gérard Goudjinou Octave Houannou Dismand Houinato Gilbert Dossou Avode Neurology Department Centre Hospitalier et Universitaire de Conakry Conakry Guinée Neurology Department Centre Hospitalier et Universitaire of Brazzaville Brazzaville Congo Neurology Department Centre National Hospitalier et Un-iversitaire Hubert Koutoukou MAGA de Cotonou (CNHU-HKM) Cotonou Benin

Introduction: Cognitive disorders frequency arising after a cardio-cerebral vascular disease (stroke) is currently on the rise due to the ageing population and the increase in the number of survivors after stroke occurrence. Objective: Determining post-stroke cognitive decline and identifying associated factors. Method: It consists in a cross-sectional, prospective, descriptive and analytical study which was conducted from April 1 to August 31, 2013 in the Neurology Department of CNHU-HKM in Cotonou. The study involved 100 patients who have known stroke for at least the past 6 months and were all admitted and discharged later on. The disease survivors were re-contacted and examined again at home or at hospital. The cognitive decline (CD) was estimated by using a modified and adapted MMSE to suit our cultural era. Results: All patients were aged 58.9 years ± 13.6 years. Sex-ratio was 1.4. Cognitive decline frequency was 20%. Post-stroke cognitive decline frequency per sex was 11.6% and 8.4% respectively for females and males. Ischemia stroke patients had a higher cognitive decline (22.5%). 58.3% had severe CD. Moreover the CD frequency increased with time, from 16.7% in a year to 50% in 3 years. Total MMSE varied from 6 to 23 with 21 as median. From the unvaried analysis, the presence of sphincter disorders (1.26 [0.35-4.59], p = 0.004), consciousness disorders (15.67 [1.46-168], p = 0.04), and convulsion disorders (3.77 [1.01 -14.00], p = 0.003) was associated with cognitive decline. From multi-varied analysis, the sole presence of convulsive attacks (11.5 [1.79-73.58], p = 0.01) was individually associated with post-stroke cognitive decline. Conclusion: This study reveals the importance of CD after stroke. The occurrence of convulsions at stroke acute stage is a prognostic factor of CD medium or long-term occurrence. The overall coverage improvement depends on the integration of these data in stroke reach-out programs.

关键词： Stroke Cognitive Decline Dementia Benin

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Role of CD4+ and CD8+ T Lymphocyte in the Onset of Stroke in People Living with HIV in Pointe-Noire

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World Journal of Neuroscience 2022年第1期12卷 1-7页

作者： Prince Eliot Galieni Sounga Bandzouzi Ghislain Armel Mpandzou Josué Euberma Diatewa Dina Happia Motoula-Latou Charles Godefroy Koubemba paul macaire ossou-nguiet Donatien Moukassa Faculty of Health Sciences Marien N’Gouabi University Brazzaville Republic of Congo Department of Neurology Loandjili General Hospital Pointe-Noire Republic of the Congo Department of Neurology University Hospital Center of Brazzaville Brazzaville Republic of Congo

Objective: To determine the role of CD4+ and CD8+ T lymphocytes in the onset of stroke in people living with HIV. Methodology: This was a descriptive, cross-sectional study from January to July 2019, in the neurology department of loandjili general hospital, including any patient hospitalized for a first episode of stroke confirmed by brain scan. The study variables were: age, sex, CRP value, serum T cell CD4+, CD8+. The statistical analysis was carried out using the EPI info 7 software. Results: Twenty stroke patients were included. The relative frequency of HIV was 20%. The risk factors were potentiated by immunosuppression of CD4+ T cells. Sixty percent (60%) of the patients had a CD4+ count 3 and the mean CD4+ count was ±191/mm3. Stroke was the predominant mechanism of injury with a frequency of 70%, the only injury mechanism of stroke in patients with CD8+ T cell count > 800/mm3 (p = 0.04). Conclusion: Risk factors are potentiated by TCD4+ lymphocyte immunosupression, also CD8+ lymphocytes of immune system activation marker are a cardiovascular risk factor for living people with HIV.

关键词： CD4+ CD8+ T Lymphocytes HIV Stroke Pointe-Noire

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Prevalence of Dementia and Its Associated Factors in Cotonou Teaching Hospital, Benin

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Advances in Alzheimer's Disease 2014年第2期3卷 94-106页

作者： Dieu Donné Gnonlonfoun Constant Adjien paul macaire ossou-nguiet Lansana Laho Diallo Octave Houannou Jocelyn Acakpo Gérard Goudjinou Dismand Houinato Dossou Gilbert Avode Epidemiology Institute FSS/UAC Cotonou Benin Neurology Department Brazzaville Teaching Hospital Brazzaville Congo Neurology Department CNHU-HKM of Cotonou Cotonou Benin Neurology Department Conakry Teaching Hospital Conakry Guinea

Introduction: Dementia constitutes a public health hazard in developing countries. There is little data in the sub-Saharan region of African especially in Benin. Objective: Determining dementia hospitalization prevalence and identifying its associated factors in CNHU-HKM, Cotonou. Method: It was a cross-sectional, prospective, descriptive and analytical research conducted from October 2012 to July 2013 in the neurology department;it involved 251 patients aged 50 and above. Dementia screening was conducted using a modified and adapted Mini Mental Scale Examination (MMSE). Dementia clinical and etiological diagnoses were respectively conducted based on DMS-IV and HACHINSKI criteria. Results: Patients were averagely aged 60.9 ± 8.1. Sex ratio (Male/Female) was 1.07. Dementia prevalence was 8.8%. This rate increased proportionally with age, from 5.3% with patients aged below 60 to 12.7% with patients aged above 60. Degenerative dementia was the most predominant type (50%). Following multi-varied analysis, smoking (RC = 6.05 [IC 95% = 1.26 - 29.38] p = 0.0001) and stroke past records (RC = 6.05 [IC 95% = 1.26 - 29.38] p = 0.001) revealed to be the factors associated with dementia. Conclusion: This research showed that dementia affects a significant part of the aging population in CNHU-HKM. It is imperative to combat its associated factors so as to defuse its prevalence.

关键词： Prevalence Dementia Elders MMSE DSMIV Cotonou Benin

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Stroke: Medium and long-term mortality and associated factors in French-speaking West Africa, case of Benin

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World Journal of Neuroscience 2014年第1期4卷 68-74页

作者： Dieu Donné Gnonlonfoun Constant Adjien paul macaire ossou-nguiet Isaac Avlessi Gérald Goudjinou Octave Houannou Jocelyn Acakpo Dismand Houinato Gilbert Dossou Avode Epidemiology Institute FSS/UAC Cotonou Benin Neurology Department CHU Brazzaville Congo Neurology Department CNHU-HKM Cotonou Benin

Introduction: Stroke is the leading cause of mortality and physical disability in sub-Saharan Africa. Objective: Determining medium-term and long-term mortality for stroke and identifying associated factors. Method: It consists in a cross-sectional, prospective, descriptive and analytical study that was conducted from April 1 to August 31, 2013 in the Neurology Department of CNHU-HKM in Cotonou. It involved patients who have known stroke for at least 6 months, and were all admitted and discharged later on. The disease survivors were re-contacted and examined again at home or at hospital. Then, the number of deceased was systematically recorded with precision of death time-limit. Results: The overall mortality rate was 29%. Mortality was higher with patients over 70 years with a frequency of 57.1%. The medium-term mortality rate was 25% against 4% for long-term. The average time-limit for death occurrence after the vascular incident was 7 months ± 6.4 months. Prognostic factors of mortality were: the age of the patient (IC95% = 7.73 [1.49 - 39.99], p = 0.015 ), marital status (IC95% = 0.27 [0.08 to 0.94], p = 0.039 ) and the presence of aphasia (IC95% = 5.52 [1.45 to 20.94 ], p = 0.012). Conclusion: Stroke mortality still remains significant, even after the patients have been discharged from hospital. A good psychological family support and efficient aphasia coverage are essential for its reduction.

关键词： Mortality Stroke Medium Term Long Term Cotonou

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Stroke after Hospitalization: Assessment of Functional Prognosis through Disability and Dependency in CNHU-HKM, Cotonou, Benin

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Neuroscience & Medicine 2014年第3期5卷 139-148页

作者： Dieu Donné Gnonlonfoun paul macaire ossou-nguiet Lansana Laho Diallo Constant Adjien Isaac Avlessi Octave Houannou Gérald Goudjinou Jocelyn Acakpo Dismand Houinato Dossou Gilbert Avode Epidemiology Institute Faculté des Sciences de la Santé de l’Université d’Abomey Calavi (FSS/UAC) Cotonou Benin Neurology Department Centre Hospitalier et Universitaire (CHU) Brazzaville Congo Neurology Department Centre Hospitalier et Universitaire (CHU) Conakry Guinea Neurology Department Centre National Hospitalier et Universitaire Hubert Koutoukou Maga (CNHU-HKM) Cotonou Benin

Introduction: Stroke results in severe disability, with impacts that are sometimes socially, emotionally or professionally dramatic and also dramatic for the cost involved in care and treatment. Objective: Assessing the functional prognosis after hospitalization and identifying associated factors. Method: It consisted in a cross-sectional, prospective, descriptive and analytical study that was conducted from April 1 to August 31, 2013 in the Neurology Department of CNHU-HKM in Cotonou. It involved 100 patients who have known stroke for at least 6 months and were all admitted and discharged later on. The disease survivors were re-contacted and examined again at home or at hospital. Disability and dependency were then measured respectively with the Rankin score and Barthel index. The STATA/IC11.0 statistical software was used as the basis for data analysis. Unvaried and multi-varied analyzes helped to identify associated factors. Results: The overall disability and dependency rates were respectively 69% and 57.7%. And the highest rate of disability (38.8%) was observed between 50 and 60 years old. However, dependency prevalence was higher in subjects above 70 years old (37.3%). Regarding gender, the prevalence of disability was 59.2% in men and rather 41.5% in women. Predictors of disability and dependency were paralysis on admission (IC95% = 0.26 [0.77 - 0.92];p = 0.036), obesity (IC95% = 0.26 [0.77 - 0.92];p = 0.012) and monthly income lower than 70$US (IC95% = 0.05 [0.01 - 0.56];p = 0.015). Conclusion: This study enabled us to assess the functional outcome of patients once discharged. The significance of motor deficit on stroke occurrence, obesity and the low monthly income were factors of poor functional prognosis.

关键词： Prognosis Functional Stroke Rankin Barthel Cotonou Benin

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Impact of Tension-Type Headaches in the Workplace in Brazzaville

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Neuroscience & Medicine 2024年第2期15卷 77-91页

作者： Happhia Dinah Boubayi Motoula Latou Josué Euberma Diatewa Ghislain Armel Mpandzou Prince Eliot Galieni Sounga Bandzouzi Jean Brice Mouendenguia Karen Lise Obondzo Aloba paul macaire ossou-nguiet Faculty of Health Sciences Universit Marien Ngouabi Brazzaville Congo Department of Neurology Brazzaville University Hospital Congo Department of Neurology Loandjili General Hospital Pointe-Noire Congo

Introduction: Tension-type headaches are the most widespread of the primary headache disorders. Due to their high prevalence, tension-type headaches represent a major public health problem with an enormous socio-economic burden. Determining their impact remains a challenge. Objective: To assess the impact of occupational tension-type headache in Brazzaville and identify associated factors. Population and Methods: This was an analytical case-control study conducted in public and private companies in the city of Brazzaville over a period of four (04) months. The case population consisted of cephalalgic employees;the control population was drawn from the same companies and was free of tension-type headaches. Study variables were divided into socio-professional, clinical and individual impact variables. Individual impact variables were represented by: the HIT-6 score, which incorporates a very broad conception of disability, covering several domains, namely: severity of pain during attacks and the restrictive and limiting nature of attacks. Results: Individual impact was severe in 18 (62.1%) men and 11 (37.9%) women. Mean age was 36.3 6.14 years for cases with severe impact. The mean duration of headache was 40.3 32.7 months for cases with severe impact. Tension headache evolved in attacks in 22 (75.9%) cases with severe impact, and continuously in seven (24.1%) cases. The average number of attacks per month was 2.52 1.04 for cases with severe impact. Cases with severe impact included 14 (48.3%) with chronic headache and 15 (51.7%) with episodic headache. Pain of severe intensity present in 48.3% of cases was associated with a severe impact of tension-type headache: OR = 151.66 [2.36 - 44245.95] and p-value = 0.037. At least one days absence from work per year was observed in 47.4% of our cases. The number of days off work per year due to tension-type headache had an interquartile range between 0 and 3 days and extremes from 0 to 14 days. It was the consequence of a sev

关键词： Impact Tension Headache Workplace

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