Disorders of Consciousness in the Acute Phase of Cerebral Infarctions in a Low-Income Country: The Case of Ouagadougou, Burkina Faso

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Résumé

Introduction
Disorders of consciousness (DOC) during the acute phase of cerebral infarctions (CI) are a strong predictor of in-hospital mortality, particularly in
settings like ours, where healthcare infrastructure and therapeutic resources are limited. The objective of this study was to determine the frequency
and identify factors associated with DOC during the acute phase of CI through a prospective, cross-sectional, descriptive, and analytical study conducted
in the university hospitals (UHs) of Ouagadougou, Burkina Faso.
Patients and Methods
This was a prospective, cross-sectional, descriptive, and analytical study involving patients aged over 18 years, admitted to the university hospitals of
Ouagadougou (UH-Bogodogo, UH-Tengandogo, and UH-Yalgado Ouédraogo) for CI within less than 72 hours of onset, confirmed by brain CT scan
and/or brain MRI, from January 1, 2022, to June 30, 2023, and who provided informed consent. Data were analyzed using EPI INFO 7.2.5.0 and IBM
SPSS Statistics 25 to describe sociodemographic, clinical, paraclinical, and both in-hospital and post-discharge outcomes over a 3-month period. To
identify factors associated with DOC, bivariate and multivariate analyses using stepwise logistic regression were performed, with a significance threshold
of p < 0.05.
Results
A total of 278 patients were hospitalized for acute CI, of whom 84 (30.2%) presented with DOC. Patients with DOC had a mean age of 61.5 ± 18.2 years,
with a male predominance (55.9%). At admission, the mean delay before hospital arrival was 41.3 hours, the mean Glasgow Coma Scale (GCS) score
was 11.7, and the mean NIH Stroke Scale (NIHSS) score was 14.2. Brain imaging at admission in patients with DOC revealed massive CI in 52 patients
(61.9%). The most frequently affected territories were the middle cerebral artery (MCA) in 73 patients (86.9%) and the anterior cerebral artery (ACA)
in 22 patients (26.2%). Hemorrhagic transformation was observed in 5 patients (9.9%). The most common biological abnormalities at admission were
hyperglycemia (46.4%), anemia (30.9%), and leukocytosis (30.9%). By the end of hospitalization, there were 29 recorded deaths (10.4%), with 25 deaths
(29.8%) among patients with DOC and 4 deaths (2%) among those without DOC (p < 0.001). Multivariate analysis showed that an initial NIHSS score
> 16 (OR = 12.78; p = 0.000), involvement of the MCA territory (OR = 1.26; p = 0.044), and massive CI (OR; p = 0.005) were significantly and independently
associated with the occurrence of DOC.
Conclusion
Disorders of consciousness are common and associated with high mortality during the acute phase of cerebral infarctions in Burkina Faso. They more
frequently complicate initially severe strokes. Early admission of stroke patients, improved availability and accessibility of diagnostic and therapeutic
tools, and the implementation of intensive stroke care units (stroke units) in our hospitals could help reduce stroke-related mortality by preventing
complications during the acute phase.

Mots-clés

Cerebral infarction; disorders of consciousness; Glasgow Coma Scale; NIHSS; Ouagadougou