Yannis K Valtis1, Maggie F Cochran2, Louine Martineau3, Bregenet Lamour4, Jeffrey B Mendel5, Aaron L Berkowitz6. 1. Harvard Medical School, Boston, MA, USA. Electronic address: yannis_valtis@hms.harvard.edu. 2. Harvard Medical School, Boston, MA, USA. Electronic address: margaret_cochran@hms.harvard.edu. 3. Hôpital Universitaire de Mirebalais, Partners In Health, Haiti. Electronic address: louinemartineau@yahoo.fr. 4. Hôpital Universitaire de Mirebalais, Partners In Health, Haiti. Electronic address: bregenetlamour@yahoo.fr. 5. Hôpital Universitaire de Mirebalais, Partners In Health, Haiti; Tufts University School of Medicine, Boston, MA, USA. Electronic address: jmendel@pih.org. 6. Harvard Medical School, Boston, MA, USA; Hôpital Universitaire de Mirebalais, Partners In Health, Haiti; Department of Neurology, Brigham and Women's Hospital, USA. Electronic address: aberkowitz3@partners.org.
Abstract
BACKGROUND: Neuroimaging is often unavailable in low-income countries, creating challenges for precise diagnosis of neurologic disease in individual patients, and impeding acquisition of precise neuroepidemiologic data for program and policy development. METHODS: We analyzed reports from 3614 head CTs performed between July 2013 and January 2016 at Hôpital Universitaire de Mirebalais, a public academic hospital in rural Haiti, extracting patients' age, study indication, and radiologic findings. RESULTS: The most common indications for head CT were headache (27%), trauma (19.9%), abnormal neurological exam (12.2%), and stroke (11.3%). The most common categories of neurologic abnormalities were traumatic (31%), vascular (25.8%), and infectious (12%). Of 291 strokes, 64% were ischemic (median age at diagnosis 60.8years, SD 17.4) and 36% were hemorrhagic (median age 52.0, SD 15.5). In patients undergoing head CT for seizures or epilepsy, 17.5% had evidence of neurocysticercosis. In patients with head trauma, 42.6% had intracranial hemorrhage or fracture. Atrophy was noted on 10% of CTs (median age 57.1; SD 23.8), and was characterized as out of proportion to age in 2% (median age 34.1, SD 15.3). CONCLUSIONS: Median age of stroke patients in this rural low-income population is lower than in high-income countries and proportion of stroke due to intracerebral hemorrhage is higher. Neurocysticercosis is present in nearly one fifth of patients with seizures/epilepsy. These findings can inform policies and programs for prevention and treatment of neurologic disease in low-income settings.
BACKGROUND: Neuroimaging is often unavailable in low-income countries, creating challenges for precise diagnosis of neurologic disease in individual patients, and impeding acquisition of precise neuroepidemiologic data for program and policy development. METHODS: We analyzed reports from 3614 head CTs performed between July 2013 and January 2016 at Hôpital Universitaire de Mirebalais, a public academic hospital in rural Haiti, extracting patients' age, study indication, and radiologic findings. RESULTS: The most common indications for head CT were headache (27%), trauma (19.9%), abnormal neurological exam (12.2%), and stroke (11.3%). The most common categories of neurologic abnormalities were traumatic (31%), vascular (25.8%), and infectious (12%). Of 291 strokes, 64% were ischemic (median age at diagnosis 60.8years, SD 17.4) and 36% were hemorrhagic (median age 52.0, SD 15.5). In patients undergoing head CT for seizures or epilepsy, 17.5% had evidence of neurocysticercosis. In patients with head trauma, 42.6% had intracranial hemorrhage or fracture. Atrophy was noted on 10% of CTs (median age 57.1; SD 23.8), and was characterized as out of proportion to age in 2% (median age 34.1, SD 15.3). CONCLUSIONS: Median age of strokepatients in this rural low-income population is lower than in high-income countries and proportion of stroke due to intracerebral hemorrhage is higher. Neurocysticercosis is present in nearly one fifth of patients with seizures/epilepsy. These findings can inform policies and programs for prevention and treatment of neurologic disease in low-income settings.
Authors: Francesco Vladimiro Segala; Elda De Vita; James Amone; Daniel Ongaro; Ritah Nassali; Bonny Oceng; Samuel Okori; Giovanni Putoto; Peter Lochoro; Jerry Ictho; Massimo Fantoni; Annalisa Saracino; Francesco Di Gennaro Journal: Infect Dis Rep Date: 2022-07-01