TITLE:
CT Scans and Delays in Diagnosis of Stroke in Senegal’s Regional Hospitals: A Multicenter Study of 655 Cases
AUTHORS:
Hamidou Deme, Nfally Badji, Léra Géraud Akpo, Oumou Dieng, Abdoulaye Dione Diop, Fallou Galass Niang, Mouhamadou Hamine Toure, Ibrahima Faye, Malick Diouf, Aicha Ndichout, Marie Mbengue, Cherif Mohamadou Aidara, Mamadou Ly, Ousmane Sano, Ndiaga Matar Gaye, Ousmane Cissé, Abdoulaye Ndoye Diop, Aissata Ly Ba, Sokhna Ba Diop, El Hadj Niang
KEYWORDS:
Stroke, CT Scans, Diagnostic Delays
JOURNAL NAME:
Open Journal of Medical Imaging,
Vol.10 No.2,
May
20,
2020
ABSTRACT: Stroke represents the 2nd cause of mortality and 1st cause of
physical disability in the adult population. In Senegal, it represents 30% of
hospitalization and 2/3 of the mortality in the department of neurology in the
capital city, Dakar. Objective: To specify the types of stroke and to
evaluate diagnostic delays in Senegal’s regional hospitals. Materials and Methods: This was a retrospective, cross-sectional, descriptive, multicentric study
for 4 years (from 2014 to 2017) including any patient presenting a clinical
suspicion with a CT scan confirmation of stroke in one of the 9 regional
hospitals in Senegal with a recruitment period of 6 months per hospital. CT
scans were performed with a 16 slices machine in 6 hospitals, 4 slices in 2
hospitals and 2 slices in 1 hospital. We studied the types and location of
strokes, the associated signs and the time from stroke onset to admission and
the time from admission to CT scan. Results: 655 patients were retained
including 322 men and 333 women for an M/F ratio of 0.96. The average age was
63 years (range: 7 years, 112 years). High blood pressure was noted in 59.2% of
patients and diabetes in 10.7% of patients. Strokes were ischemic in 76% of
cases involving the middle cerebral artery in 73% of cases and hemorrhagic in
24%, of which 80.7% were deep localized. A mass effect was noted in 7.5% of
cases, an engagement in 6.9% of cases and ventricular hemorrhage in 2.7% of
cases. The delay between the onset of the deficit and admission was less than 6
hours in 10.6% of patients. The time between the onset of stroke and admission
to hospital was specified in 416 patients (63.5%) of the study population, it
was less than 6 hours in 10.6% of patients, between 6 hours and 24 hours for
29.3% and more than 24 hours for 60.1%. Between admission and the CT scan, the
time was precise in 459 patients (70%), it was less than 6 hours in 37.9%,
between 6 hours and 24 hours in 43.6 % and more than 24 hours in 18.5%. Conclusion: CT is central to the diagnosis of stroke in rural areas. However, there is
a significant delay in diagnosis and management.