A Prognostic Challenge of Brainstem Stroke for the Countries of Sub-Saharan Africa: Case of Togo

Abstract

Background and purpose – Brainstem stroke (BSS) is a particular anatomo-clinical variety of strokes. In Sub-Saharan Africa, its epidemiological, therapeutic and prognostic data are rare. The aim of the study was to describe epidemiological aspects and factors associated with the prognosis of BSS in adult patients followed-up at University Hospital Campus of Lome. A prospective cohort study was carried out from January 1st 2014 to June 30th 2017 (3.5 years) in the department of neurology. It included patients with BSS. Epidemiological characteristics, initial symptoms, brain imaging findings at admission, etiologic factors, therapeutic particularities and outcome measures were assessed. Among the 2,857 patients with stroke, 79 cases of brainstem (2.8%) were diagnosed. Ischemia and hemorrhage were identified in 50 (63.3%) and 29 (36.7%) patients, respectively. Recurrence was observed in 8 patients (10.1%). Hypertension was the main etiological and risk factor. Motor physiotherapy and speech therapy implemented early and associated with other therapies in survivors, had led to the improvement of general state of more than half of the latter. Early mortality and overall mortality were 24 and 31.6%, respectively. Unfavourable prognosis was strongly correlated with diagnosis delay, high blood pressure, deep loss of consciousness, big hematoma volume, presence of encephalic complications and occlusion of basilar arterial trunk. BSS is a less common illness. The main factors identified are associated with an elevated rate of death. Vital prognosis improvement results in factor management and functional rehabilitation.