Hemorrhagic Stroke: Post External Ventricular Drainage Evolution
Rasolonjatovo EC1*, Mampiandranosy TH1, Rakotovao KT1, Tsiaremby MG1, Ratovondrainy W2, Rabarijaona M3 and Andriamamonjy C1
1Department of Neurosurgery University Hospital Joseph Ravoahangy
2Department of Neurosurgery Hospital Center Soavinandriana, Antananarivo
3Department of Neurosurgery University Hospital Tambohobe Fianarantsoa
*Corresponding Author: RASOLONJATOVO EC, Department of Neurosurgery
University Hospital Joseph Ravoahangy Andrianavalona, Antananarivo.
July 12, 2022; Published: October 10, 2022
Introduction: A hemorrhagic stroke results in a sudden neurological deficit secondary to an eruption of blood in the cerebral parenchyma. External CSF drainage is indicated in cases of intracranial hypertension following acute hydrocephalus due to ventricular flooding.
Objective: Evoke the postoperative prognosis of hemorrhagic stroke treated by external ventricular bypass in the context of Madagascar
Materials and Methods: We conducted a descriptive retrospective study of 61 cases of hemorrhagic stroke treated by external ventricular drainage at the Neurosurgery and Surgical Resuscitation Department of the CHUJRA, between January 2018 and December 2020. The epidemio-clinical, computed tomographic, therapeutic and outcome parameters are described in order to identify the postoperative prognosis using the preoperative ICH score.
Results: The average age of the patients was 55.09 years with a majority in the age groups of 44 to 65 years. There is a slight male predominance. The symptomatology is dominated by the motor deficit syndrome like hemiplegia in 73.77% of the patients, then the syndrome of intracranial hypertension in 34.42%. The main risk factor was high blood pressure (93.44%) followed by alcohol and smoking (50.81%). Brain computed tomography showed ventricular flooding with acute hydrocephalus in 75% of cases. Fifty-one patients (83.61%) had an ICH score between 2 and 3. The used surgical technique was external drainage of CSF with or without hematoma evacuation. Among the postoperative complications (52.45% of cases), CSF infection is the most common (39.34%) followed by mechanical complications (25%). The mortality rate was 52.45%. Mortality factors were associated with severe initial impaired consciousness, a high ICH score greater than or equal to 3 and infections (pleuropulmonary and meningitis).
Conclusion: Morbi-mortality due to hemorrhagic stroke remains high in this study. External drainage of CSF has its place in emergency treatment. Prevention and treatment of CSF infection remains a real challenge.
Keywords:Hemorrhagic Stroke; External Drainage of Cerebrospinal Fluid; Hydrocephalus; Meningitis
- Anderson C., et al. “Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage”. The New England Journal of Medicine 25 (2013): 2355-2365.
- L’hermite Y., et al. “Accident Vasculaire Cérébral hémorragique”. Urgence 39 (2013): 2.
- , et al. “Care of the patient undergoing external ventricular drainage in Neurosurgical Intensive Care Unit”. Médecine Intensive Réanimation (2016): 1-2.
- Lemesle M., et al. “Incidence trends of ischemic stroke and transient ischemic attacks in a well-defined French population from 1985 through 1994”. Stroke 2 (1999): 371-377.
- Lemesle M., et al. “Épidémiologie des accidents vasculaires cérébraux: son impact dans la pratique médicale”. EMC - Neurologie1 (2006): 1-16.
- Aboderin I., et al. “pan European consensus meeting on stroke management”. Stroke Journal of Internal Medicine (1996): 240.
- Mendelow AD., et al. “Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebralhaematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial”. Lancet 365 (2005): 387-397.
- Davenport R., et al. “Neurological emergencies: acute stroke”. Journal of Neurology, Neurosurgery, and Psychiatry 68 (2000): 277-288.
- Weimar C., et al. “Development and validation of the Essen Intracerebral Haemorrhage Score”. Journal of Neurology, Neurosurgery, and Psychiatry 77 (2006): 601-605.
- Jean de Recondo. “Sémiologie du système nerveux”. Flammarion, (Paris ) (1997): 423-456.
- Rolak L and Ruckey R. “Coronary and cerebral vascular diseases”. Futura publishing company, (New York) (1990): 251-2522.
- Brott T., et al. “Early Hemorrhage Growth in Patients with Intracerebral Hemorrhage”. Stroke 1 (1997): 1-5.
- Sahani R and Weinberger J. “Management of intracerebral hemorrhage”. Vascular Health and Risk Management5 (2007): 701-709.
- Kase CS. “Intracerebral Hemorrhage: Non-Hypertensive Causes”. Stroke4 (1986): 590-595.
- Broderick JP., et al. “Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality”. Stroke7 (1993): 987-993.
- Mananjo D., et al. “Facteurs predictifs de mortalité précoce des accidents vasculaires cérébraux dans le service ATUR du CHU/JRB (30cas)” . La Revue Médicale de Madagascar 1 (2016): 676-680.
- Torbey MT. “Intracerebral hemorrhage: what's next?” Stroke 4 (2009): 1539-1615.
- Bogousslavsky J., et al. “Accident vasculaire cérèbraux”. Doin (Paris) (1993): 136.
- Morgenstern LB., et al. “Guidelines for the Management of Spontaneous intracerebral hemorrhage: A Guideline for Healthcare Professionals from the American Heart association/Americain stroke association”. Stroke9 (2010): 2108-2129.
- Jeanne T and François S. "Surprise !La tomodensitométrie révèle un AVC hémorragique” . Le Médecin du Quebec 6 (2006): 79-85.
- Adeoye O., et al. “Eligibility for the Surgical Trial in Intracerebral Hemorrhage II Study in a Population-based Cohort”. Neurocritical Care2 (2008): 237-241.
- Auer LM., et al. “Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study”. Journal of Neurosurgery 4 (1989): 530-535.
- Zhu XL., et al. “Spontaneous intracranial hemorrhage: which patients need diagnosis cerebral angiography? A prospective study of 206 case and Review of the literature”. Stroke 7 (1997): 1406-1409.
- Shiomi N., et al. “Simultaneous multiple hypertensive intracerebral hematoma”. Neurological Surgery3 (2004): 237-344.
- Hemphil JC., et al. “The ICH score: a simple, reliable gradind scale for intracerebral hemorrhage”. Stroke 4 (2001): 891-897.
- Bilbao B., et al. “A prospective study of a series of 356 patients with supratentorial spontaneous intracerebral haematomas treated in a Neurosurgical Department”. Acta Neurochirurgical 8 (2005): 823-829.
- Mahoungnou G., et al. “Hemorrhagic strokes management in resuscitation brazzaville congo”. Anesth.Med.Urg 17.3 (2012): 50-54.
- Goldstein JN., et al. “Critical care management of acute intracerebral hemorrhage”. Current Treatment Options in Neurology 2 (2011): 204-216.
- Roitberg BZ., et al. “Bedside external ventricular drain placement for the treatment of acute hydrocephalus”. British Journal of Neurosurgery 4 (2001): 324-327.
- Ido F., et al. “Complications infectieuses des accidents vasculaires cérébraux en neurologie au CHU de Bogodogo university hospital, à Ouagadougou”. Neuropsychiatry 123 (2021): 170-175.
- , et al. “Management problems in acute hydrocephalus after subarachnoid hemorrhage”. Stroke 20.26 (1989): 747-753.
- Kusske JA., et al. “Ventriculostomy for the treatment of acute hydrocephalus following subarachnoid hemorrhage”. Journal of Neurosurgery 5 (1973): 591-595.