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Resume Introduction Les accidents vasculaires cerebraux (AVC) representent la premiere affection et la premiere cause de deces en neurologie a Dakar (Senegal). Le coma est un mode de revelation et un signe de gravite. L’objectif de ce travail etait de determiner les caracteristiques des AVC comateux et d’evaluer la survie de ces patients. Patients et methode Nous avons mene une etude prospective longitudinale des patients admis pour AVC entre avril 2006 et juillet 2007 au service de neuroreanimation du centre hospitalier universitaire de Fann (Dakar, Senegal). Etaient inclus dans l’etude, tout patient victime d’AVC confirme par le scanner cerebral et presentant un score de Glasgow inferieur ou egal a 8/15. Les patients presentant une hemorragie sous-arachnoidienne ont ete exclus. Resultats Cent cinq patients, d’âge moyen 61,9 ± 14,2 ans, ont ete inclus dans l’etude : 54 cas d’accident ischemique cerebral et 51 cas d’hemorragies cerebrales. La duree moyenne du sejour en neuroreanimation etait de 10,8 ± 11 jours et la mortalite estimee a 82,9 %. La mediane de survie etait de 7 ± 1 jours (IC 95 % : 5–9) ; la survie a j90 etait de 9,5 %. Conclusion Les AVC comateux ont un pronostic severe ; ces resultats soulignent l’importance de la prevention primaire.

Thirty-five percent of stroke events observed in Dakar, Senegal involve hemorrhaging. Coma is a frequent revealing sign of the disease and a severe prognostic factor. Since specific therapy is unavailable in sub-Saharan Africa, only symptomatic medical treatment is proposed to most patients presenting intracerebral hemorrhage. The purpose of this longitudinal study was to evaluate prognosis and survival in patients presenting with intracerebral hemorrhage in a neurological critical care unit in Senegal. Study was conducted from April 15, 2006 to July 18, 2007 in the neurological critical unit of the Fann University Hospital Center in Dakar. Mortality and probability of survival were estimated using Kaplan Meier methods. The predictive value of factors significantly correlated with prognosis was determined by multivariate analysis using a Cox proportional hazards model. A total of 51 cases of intracerebral hemorrhage were included in this study. Mean patient age was 64 years and the sex ratio was 1.13. Median survival was 7 days and mortality in the neurological critical care unit was 80.4%. The probability of survival at days 10, 30 and 90 were 43.14%, 21.57% and 13.73% respectively. Occurrence of a complication on day 3 was shown to be an independent risk factor for early death. Intracerebral hemorrhage with coma is associated with a high mortality rate. Better primary prevention is necessary.

In Dakar, stroke is the most frequent neurological disease with the highest mortality. Victims may present in a critical state of coma. The objective of this study was to evaluate survival among comatose stroke patients in Dakar, Senegal.This was a longitudinal prospective study from April 2006 to July 2007 conducted in the Neurological Intensive Care Unit (NICU) of Fann University Teaching Hospital in Senegal. Were included in the study, all stroke patients confirmed by CT scan with a Glasgow coma score less than or equal to 8/15. Patients with subarachnoid hemorrhage were excluded.A total of 105 patients were evaluated with 54 cases of ischemic stroke among them. The mean age was 61.87+/-14.16 years. The mean duration of hospital stay in the NICU was 10.82+/-11 days with an estimated mortality of 82.9%; the three-month survival was 9.52%. The median overall survival was 7+/-1 days (CI(95%): 5-9).Comatose stroke patients have a poor prognosis, emphasizing the crucial importance of primary prevention.