The pattern of radiological findings seen in four-vessel cerebral angiography done at the KNH and Nairobi Hospital

Abstract

Introduction: Most of the intracranial cerebrovascular pathologies commonly present with subarachnoid hemorrhages and cerebrovascular accidents, which are associated with significant morbidity and mortality. Imaging plays a crucial role in diagnosis and subsequent management of these patients. The imaging modalities available include catheter angiography, computerized tomographic angiography and magnetic resonance angiography. Four-vessel cerebral Digital Subtraction Angiography (DSA) is used to make accurate diagnosis and pre-operative delineation of intracranial aneurysms, and arteriovenous malformation (A VM). It also provides information about the calibre and occlusion of cerebral vasculature. DSA thus plays an essential role in planning neurosurgical and interventional neuroradiological procedures. ** Objective: The purpose of the study was to evaluate the pattern of cerebrovascular diseases as seen at a teaching and a tertiary angiographic centre in Nairobi. ** Methodology: This was a cross-sectional descriptive study of angiographic findings of patients who were done four-vessel studies at KNHlNairobi Hospital CA TH laboratories from January 2005 to January 2006. ** Results: A total of 88 patients were evaluated with four-vessel digital subtraction brain angiography during the study period. The male to female ratio was I: I.I.The mean age was 40.3 years. Angiographic pathology was identified in 77.3% of the study subjects. Angiographic findings included aneurysm (40.9%), vascular stenosis/spasm (14.8%), AVM (8.0%) and angiographic normal (22.7%). Anterior (carotid) circulation aneurysms arising within the circle of Willis accounted for 95.2% of all the aneurysms. Aneurysms were multiple in 16.7 % of all cases with male to female ratio of 1:5. ** Conclusion: The pattern of cerebrovascular disease seen in KNH and Nairobi Hospital was comparable to those in other setups. Cerebrovascular pathologies were commonest in the age group 41-60 years. Aneurysms were the commonest cerebrovascular pathologies and they were significantly more (p=0.007) in females compared to males. Slightly more than a fifth of all cases were angiographically negative.