Epidemio-clinical and CT-scan profile of adult headache disorders in a sub-Saharan Africa country

Résumé

Objective: Given the little availability of MRI in sub-Saharan Africa, we carried out this study focusing on CT-scan in adult headache disorder, in order to determine epidemiological and clinical profile of adult patients undergoing CT-scan for headache disorder, and the organic pathologies discovered in sub-Saharan Africa.

Method: We carried out a multicentric prospective cross-sectional study in medical imaging departments of Yaounde Central Hospital and Douala Laquintinie Hospital, which are two teaching hospitals in Cameroon. We consecutively and non-exhaustively included all consenting patients aged eighteen years or above, referred to radiology department  to undergo a head CT-scan as aetiological workup of headache disorder, from either traumatic or non-traumatic mechanism. Patients with a Glasgow coma scale less than thirteen were excluded. We interviewed eligible patients, and performed a neurological examination and a complete physical examination before they underwent head CT-scan. The scanning was performed using a brand HITACHI ECLOS 16 slices CT-scan, in helical mode with or without contrast enhancement according to the clinical context. The reading was done by experimented radiologists.

Results: The total number of patients was 169. There was a predominance of men (56.2%) and the average age was 43 years. Headache was secondary to a minor brain trauma in 37.2% (n= 63) of patients and 82.5% (n= 52) of trauma were due to the public highway accident. 78.1% (n= 132) of patients performed head CT-scan for acute headaches, of which 45.6% were recent sudden-onset headache and 32.5% were recent progressive headache. Headache was associated to an abnormal neurological examination in 72.8% (n= 123) of cases, fever in 20.7% (n= 35), and there were no associated clinical symptoms in 5.3% of cases. There was a notion of hypertension in 21.3% of cases (n= 36), HIV in 10.1% of cases (n= 17), and past history of stroke in 7.7% of cases (n= 13). In 38.5% of cases, CT findings were normal. CT-scan revealed 4 cases (2.4%) of incidental findings. CT revealed in 59.2% (n= 100) of cases the cause of headache disorder. These causes were dominated in non-traumatic headaches by stroke (13.6%), sinusitis (12.4%), encephalitis and abscesses (7.1%); and in post-traumatic headaches by intracranial haemorrhages (25%), followed by skull fractures (14.2%).

Conclusion: Headache is a symptom commonly explored in neuroradiology in sub-Saharan Africa, particularly the Cameroon. Traumatic causes are frequent in our setting. The major findings observed on CT-scan are stroke, sinusitis, encephalitis and abscess in non-traumatic headache disorder, and intracranial haemorrhage, skull fractures in traumatic context.