Cardio-embolic stroke: Lessons from a single centre in Sub-Saharan Africa

Area of Science:

• Neurology
• Cardiology
• Public Health

Background:

• Limited data exists on cardio-embolic stroke (CES) in sub-Saharan Africa.
• This study aims to describe CES epidemiology, clinical features, etiology, management, and outcomes in the region.

Purpose of the Study:

• To characterize the epidemiology of cardio-embolic stroke in sub-Saharan Africa.
• To identify the primary causes and clinical presentation of CES.
• To evaluate the management strategies and patient outcomes for CES.

Main Methods:

• Retrospective cohort study at Douala General Hospital.
• Inclusion of ischemic stroke patients admitted to Neurological and Intensive Care Units.
• Collection of socio-demographic, clinical, and paraclinical data, with follow-up for mortality, recurrence, and functional outcome (Barthel score).

Main Results:

• CES represented 23.4% (86/368) of ischemic strokes, with a mean patient age of 67 years.
• Atrial fibrillation (82.1%) was the leading cause, followed by dilated cardiomyopathy (12.8%).
• In-hospital mortality was 23.3%, predicted by lesions in both internal carotid arteries and heart disease. Five-year survival was 10%, with stroke recurrence in 12.1%.

Conclusions:

• CES constitutes a significant proportion of ischemic strokes in the region, associated with high early mortality and long-term recurrence.
• Atrial fibrillation is the predominant etiology of CES.
• Combination therapy of Vitamin K Antagonists (VKA) and anti-platelet agents should be avoided in acute CES to reduce early mortality.