Patterns of Clinical Presentation and Radiological Findings in Patients with Haemorrhagic Stroke Reviewed by the Neurosurgery Service at a Tertiary Hospital in Southern Nigeria

Research Article

Abstract

Background: Haemorrhagic stroke (HS) carries disproportionate mortality in sub-Saharan Africa, where hypertension is highly prevalent and often inadequately controlled. Understanding the clinical and radiological profile of HS patients referred for neurosurgical evaluation is essential for guiding prevention and resource allocation.

Objective: To describe the demographic characteristics, clinical presentation, risk factor profile (with emphasis on hypertension), and computed tomography (CT) findings of patients with non-traumatic HS reviewed by the neurosurgery service at Rivers State University Teaching Hospital, southern Nigeria.

Methods: This retrospective cross-sectional study included consecutive patients with CT-confirmed, non-traumatic HS reviewed by neurosurgery over 12 months (March 2025 – February 2026). Patients managed solely by neurologists without neurosurgical consultation were excluded. Data on demographics, risk factors, symptoms, examination findings, CT features, ICH score, and WFNS grade were analysed using descriptive statistics.

Results: Sixty-two patients were included (56.5% male; mean age 53.4 ± 11.5 years). Hypertension was the dominant risk factor, documented in 79.0% of the cohort and 96.1% of patients with recorded blood pressure status. Loss of consciousness (72.6%) was the most common presenting symptom. The mean admission Glasgow Coma Scale score was 8.8 ± 3.7, with 50.8% of patients presenting with severe impairment (GCS 3–8). On CT, deep hypertensive-type haemorrhages predominated: capsuloganglionic/basal ganglia (33.9%) and thalamic (27.1%). Intraventricular extension occurred in 58.1% and hydrocephalus in 38.7%. Disease severity was objectively high: among 50 patients with a calculated ICH score, 18 (36.0%) scored 3 or 4, indicating high predicted mortality; among 30 patients graded on the WFNS scale, 25 (83.3%) presented in poor grade (WFNS 4 or 5). In-hospital mortality was 32.3%.

Conclusion: Patients with haemorrhagic stroke referred to the neurosurgery service in our centre present with profound neurological compromise, as reflected by low admission GCS, high ICH scores, and predominantly poor WFNS grades. Hypertension remains the overwhelming modifiable risk factor. These findings underscore the urgent need for community-based hypertension control programmes and strengthened neurosurgical critical care capacity in southern Nigeria.