Correlation between silent lacunar strokes and retinopathies seen on fundus among patients hospitalized for lacunar strokes: An observational study at the neurology department of Befelatanana University Hospital.

Retinal and cerebral arterioles have similar characteristics. Silent infarcts are associated with a risk of incident lacunar stroke and dementia. The objective of our study was to determine the correlation between silent lacunar strokes and retinopathy in patients hospitalized in our department for lacunar strokes. This is an observational, retrospective study, from July 2018 to December 2019, of patients diagnosed with lacunar stroke at the neurology department of Befelatanana Hospital, Antananarivo. Stroke was diagnosed with brain CT scan and retinopathy was classified according to fundus examination. The correlation between the presence of silent lacunar stroke and different types and stages of retinopathy was studied. Silent lacunar lesions were discovered on imaging in 70.59% of patients with lacunar strokes. All patients with symptomatic lacunar stroke, with or without associated silent lacunar lesions, were hypertensives. No statistical difference was found between patients with or without associated silent lacunar lesions according to age and gender. Among patients with silent lacunar lesions, dysexecutive syndrome was more prevalent as compared to patients without silent lesions (52.63% vs. 47.36%, P=0.03). Arteriolopathy was more prevalent in patients with silent lacunar lesions (85.71% vs. 14.28%, P=0.047). Silent lacunar lesions were unique in 72% of cases (P=0.022). The presence of stage II hypertensive retinopathy was significantly correlated with the presence of silent lacunar lesions (OR 5.20 [1.02-267] [1.02-26.47], P=0.018). Upon discovery of stage II hypertensive retinopathy on fundus examination, brain imaging should be performed for silent lacunar stroke screening to optimize hypertension management. This management is expected to prevent the incidence of lacunar stroke and vascular dementia.

Motor deficit outcome in patients with stroke in the neurology unit of the Befelatanana University Hospital in Antananarivo.

A stroke is the sudden onset of focal neurological deficits presumed to have mecanism vascular and is the leading cause of acquired motor disability in adults. To improve stroke management, we examined the motor disability of patients presenting with stroke, their course, and its determinant factors. This retrospective descriptive study reviewed case records from the neurology unit of the Befelatanana University Hospital from january to december 2015. We included all patients who had a stroke with motor impairment of any upper or lower limbs, with or without computed tomography of the brain, that is, 227 (36.50 %) of the 622 patients admitted to the neurology unit. The mean age of onset was 55.41 years with a sex-ratio 1.16. Predominantly, we found perforating artery strokes (51.54 %), ischemic strokes (36.12 %), and right limb location deficits (50.22 %). Stroke patients were managed with physical therapy from the beginning of the acute stage, that is, from the admission (77.53 %). Two third of the motor deficits were steady (67.84 %), with a median NIHSS=8 and MRS=4 at hospital discharge. The mortality rate was 8.37 % (6.60 % during the first week and 1.77 % after that). We found no significant determinant factors. Hospital mortality decreased during the study. The lack of overcoming of motor disability was due to the short follow-up period, which included only the acute stage. These findings point out the utility of a neurovascular unit (UNV) for reducing disabilities and developing a network for stroke management during the acute stage in Madagascar.