Angiography of stroke in Central Africa

Stroke is prevalent in Africa, hypertension being the most common underlying cause. Yet in 113 patients suffering from this condition who were investigated with cerebral angiography in Zambia, abnormalities were found in 46 patients of whom only six were hypertension. Atherosclerosis was rare, seen only in four patients. Occlusion of a cerebral vessel was common and was demonstrated in 32 patients; 19 of these patients were young and showed occlusions or high grade stenoses of the supraclinoid segment of the internal carotid artery, with secondary contraction of the proximal artery. Other angiography findings included five subdural hematomas, three brain tumours, two cerebral abscesses, and one middle aneurysm. The yield of positive findings is high and a significant proportion are amenable to treatment. This pattern of stroke is different from that seen in Caucasians in the Western world and angiography is invaluable in detection of treatable conditions.