Neurosurgical management of spontaneous intracerebral haematoma in a resource-limited setting: profile and challenges
Keywords:
Spontaneous Intracerebral Haematoma, SICH, stroke, neurosurgery, resource-limited setting, Sub-Saharan AfricaAbstract
Background: Spontaneous inracerebral haematoma (SICH) is the most devastating
type of stroke and challenges of its care in resource-limited settings may worsen its
gloomy outlook. There is a need to provide neurosurgical data for SICH in resourcelimited settings. This study provides information about SICH in such a setting.
Method: We conducted a retrospective review of patients who had neurosurgery for
SICH at the UNIOSUN Teaching Hospital, Osogbo, Nigeria over an eleven year
period (October 2011 to June 2022). Demographics, clinical presentations,
operative procedures and outcomes/challenges of care were reviewed. Descriptive
and inferential data analyses were performed.
Results: Sixteen patients had neurosurgical procedures for SICH but only 15 had
complete data. Males were 13/15(86.7%) and most (66.7%) had admission GCS =8.
The mean age was 58.8years (range: 34-80). Most of the patients were elderly
(53.3%). Systemic hypertension was the cause in 14(93.3%). There was right-sided
and lobar predominance (60.0% and 46.7% respectively) and most (80.0%) had
intraventricular extension. The commonest procedure was external ventricular
drainage (86.7%) with or without craniotomy (20.0%) / burr hole (13.3%) for
haematoma evacuation. Twelve (80.0%) of the patients died. Predictors of poor
outcome were low admission GCS, brainstem dysfunction, aspiration/chest
infection, seizures and long ictus-to-operation time. Identified challenges of care
included delay in presentation, delay in getting CT, difficulty with blood pressure
control, lack of hospital facilities and tortuous referral pathway.
Conclusion: The high mortality of SICH and its gloomy outlook may be
improved upon by tackling the various identified challenges surrounding its
care.
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