Background/Aim: Hemorrhagic transformation (HT) of cerebral infarction (CI) is one of the complications arising in the acute phase of CI, which significantly increases mortality and worsens the functional prognosis of patients. However, the HT of CI is little studied in our context. The aim of our study was to assess the frequency and identify the factors associated with HT in the acute phase of CI in the university hospitals (UH) of Ouagadougou in Burkina Faso.
Materials and Methods: It was a descriptive and analytical cross-sectional study, with prospective data collection, of HT in the acute phase of CI in Ouagadougou's teaching hospitals (UH Yalgado Ouédraogo, UH-Tingandogo, UH-Bogodogo), from July 1, 2022 to September 30, 2022. Patients aged over16 years were included, admitted to the 3 UHs for CI diagnosed on CT and/or MRI and dating back no more than 24 hours, during the study phase. Symptomatic hemorrhagic transformation (SHT) was diagnosed at follow-up CT
performed as part of the investigation of neurological deterioration, corresponding to a recent increase in baseline neurological deficit ≥ 4 points at initial NIHSS. The frequency, clinical, paraclinical and evolutionary data of CI with SHT were described. Univariate and then multivariate analysis with Cox logistic regression identified sociodemographic, clinical and paraclinical characteristics independently associated with the occurrence of SHT, with p value ˂ 0.05.
Results: Twenty-one (21) patients presented with SHT out of a total of 211, representing a frequency of 9.9% with a M/F sex ratio of 1.1. The mean age of patients was 58.7 years (±19.6 years). Increased neurological deficit was the main clinical feature of SHT, with 13 cases (61.9 %). The CI was large in 9 patients (42.9%); mass effect in 17 cases (80.9%), extensive cerebral edema with 12 cases (57.1%) were the main associated neuroradiological abnormalities. The in-hospital mortality rate was 61.9%. The variables independently associated with the occurrence of SHT, present at admission, identified were: history of diabetes (OR=1.27; p=0.001), initial severe neurological deficit (NIHSS≥ 17) (OR=1.41; p=0.041), hyperglycemia on admission (OR=2.31; p=0.004); large CI on admission (OR=12.4; p=0.0001), brain involvement on admission (OR=10.61; p=0.001), extensive cerebral edema on admission (OR=29.0; p=10-4); cardio-embolic etiology of the CI (OR=2.23; p=0.013).
Conclusion: SHT complicates 1 in 10 CI in the hospital phase, and is associated with an appalling prognosis, with death in 3/5 of patients and loss of autonomy in most survivors. Markers of early CI severity, initial hyperglycemia and cardioembolic etiology are the risk factors for its occurrence. The establishment of dedicated stroke care networks, the implementation of stroke units, and the availability of thrombolysis and mechanical thrombectomy in our hospitals, would contribute to improving the vital and functional prognosis of stroke patients.

cerebral infarction; symptomatic hemorrhagic transformation; in-hospital mortality; risk factors; ouagadougou