ABSTRACT
Background: Although Subarachnoid Hemorrhage (SAH) is an emergency condition, its epidemiology and prognosis remain poorly understood in Africa. We aim to explore the clinical presentations, outcomes, and potential mortality predictors of primary SAH patients within 3 weeks of hospitalization in a tertiary hospital in Sudan. Methods: We prospectively studied 40 SAH patients over 5 months, with 3 weeks of follow-up for the symptomatology, signs, Glasgow coma scale (GCS), CT scan findings, and outcomes. The fatal outcome group was defined as dying within 3 weeks. Results: The mean age was 53.5 years (SD, 6.9; range, 41-65), and 62.5% were women. One-third (30.0%) were smokers, 37.5% were hypertensive, two-thirds (62.5%) had elevated blood pressure on admission, 37.5% had >24 hours delayed presentation, and 15% had missed SAH diagnosis. The most common presenting symptoms were headache and neck pain/stiffness, while seizures were reported in 12.5%. Approximately one-quarter of patients (22.5%) had large-sized Computed Tomography scan hemorrhage, and 40.0% had moderate size. In-hospital mortality rate was 40.0% (16/40); and 87.5% of them passed away within the first week. Compared to survivors, fatal outcome patients had significantly higher rates of smoking (50.0%), hypertension (68.8%), elevated presenting blood pressure (93.8%), delayed diagnosis (56.2%), large hemorrhage (56.2%), lower GCS scores at presentation, and cerebral rebleeding (P < 0.05 for each). The primary causes of death were the direct effect of the primary hemorrhage (43.8%), rebleeding (31.3%), and delayed cerebral infarction (12.5%). Conclusions: SAH is associated with a high in-hospital mortality rate in this cohort of Sudanese SAH patients due to modifiable factors such as delayed diagnosis, hypertension, and smoking. Strategies toward minimizing these factors are recommended.
ABSTRACT
OBJECTIVES: This study examines the usefulness of computed tomography (CT) scans in evaluating patients with dizziness in the emergency department (ED). METHODS: Medical records of patients presented with complaints of dizziness or vertigo to the ED of a tertiary university hospital and underwent head CT scans from July 2015 to June 2018 were reviewed. The patients' demographic information, presenting symptoms, and final head CT scan and Magnetic resonance imaging (MRI) results were collected. Stepwise logistic regressions were used to analyze data. RESULTS: A total of 326 dizzy patients were included in this study. The majority of the patients (83.1%) were older than 44 years. Acute vertigo pattern of dizziness was detected among 50.6% of the patients and was more common among females than males (p < 0.001). Of these 326 patients who underwent head CT scans, 49 (15%) had abnormal findings with acute ischemic stroke was the most common one. A total of 191 patients underwent follow-up studies. MRI accounted for 70% of the follow-up studies. Of the 134 patients who received MRI of the brain, 36 (27%) had abnormal findings. A significant correlation of RBCs level, presence of other symptoms, and frequency of episodes with the presence of vertigo (p < 0.001) was found. CONCLUSION: The study's findings indicate low effectiveness of head CT scan compared to MRI for dizziness management. Future studies are suggested to provide more insights into the cost-effectiveness and utility of head CT scans and MRI in providing valuable findings.
