Title : Hemorrhagic stroke in young adults in Cameroon (Sub-Saharan Africa): Risk factors and six-year outcomes from a retrospective cohort study
Abstract:
Background: Hemorrhagic stroke (HS) is increasingly affecting young adults in sub-Saharan Africa, where it is associated with severe disability, high mortality, and profound socioeconomic consequences. Despite this growing burden, data describing the clinical characteristics and outcomes of young adults with HS in Cameroon remain limited.
Objectives: This study aimed to determine the clinical characteristics, vascular risk factors, and outcomes of hemorrhagic stroke among young adults managed at two regional referral hospitals in Cameroon.
Materials and Methods: A hospital-based retrospective cohort study was conducted using medical records of patients aged 18–54 years with CT-confirmed intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) admitted to the Buea and Limbe Regional Hospitals between January 2020 and December 2025. Sociodemographic, clinical, radiological, treatment, and outcome data were extracted. Functional outcomes were assessed using the modified Rankin Scale. Predictors of mortality were identified using multivariable logistic regression, while survival was estimated using Kaplan–Meier analysis. Statistical significance was set at p < 0.05.
Among 1,181 stroke patients identified, the overall prevalence of hemorrhagic stroke was 31.7%, with young adults accounting for 55.6% of all HS cases. Intracerebral hemorrhage represented 87.3% of cases, while subarachnoid hemorrhage accounted for 12.7%. Headache, altered consciousness, and aphasia/dysarthria were the predominant presenting features. Hypertension (60.0%) and alcohol use (26.6%) were the most common vascular risk factors. Basal ganglia hemorrhage was the commonest anatomical location (63.9%), while only 2.0% of patients underwent neurosurgical intervention. The cumulative case fatality rate reached 43.0% at six months. Among survivors, functional recovery improved substantially over time, with 95.5% achieving a good functional outcome by six months. Independent predictors of in-hospital mortality included moderate Glasgow Coma Scale score (aOR 9.14), severe Glasgow Coma Scale score (aOR 18.16), mass effect (aOR 6.16), and hyperthermia (aOR 2.52). The 6-month survival rate was 59.0%. The HS subtype and the Glasgow coma score were the predictors of survival.
Conclusion: Hemorrhagic stroke affects a substantial proportion of young adults in Cameroon and remains associated with considerable mortality. Hypertension and alcohol use were the most frequently identified vascular risk factors, while impaired consciousness, mass effect, and hyperthermia independently predicted poor survival. These findings underscore the need for improved primary prevention, earlier recognition, and strengthened acute stroke care in resource-limited settings.
