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Introduction: Severe strokes have poor prognosis by their heavy motor and cognitive consequences. Objective: To describe the epidemiological, clinical and therapeutic aspects of these strokes. Material and Method: A retrospective and analytical study was conducted from January 2015 to December 2016 in the neurology department of our University Hospital. The diagnosis of severe stroke was based on clinical criteria (NIHSS score greater than 17, Glasgow score less than 9, and a WFNS stage greater than or equal to IV); and CT scan criteria (stroke location in the posterior fossa, carotid and Sylvian malignant infarction, cerebral hemorrhage with ventricular flood and mass effect). Results: We recorded 1964 strokes and 163 patients had severe stroke with a frequency of 8.3%. Of the 163 severe strokes, ischemic were observed in 38.7% and hemorrhagic for 61.3%. The average age was 55.8 ± 12.8. The motor deficit (76.1%) and disturbances of consciousness (62.6%) were the most admission signs. High blood pressure was the main risk factor (64.8%) and the etiology of hemorrhage in 83.5%. Atherosclerosis was the main etiology (86.4%) of ischemia. The hemorrhagic lesions location was diencephalic (67.7%) and brainstem (21.7%). Overall mortality was 44.8%, including 72.6% of early mortality due to haemorrhage. Predictive factors of mortality were the high NIHSS score, low Glasgow score, presence of ventricular flood, and high volume of hematoma. Conclusion: The high incidence of severe stroke and its early mortality rate demonstrate that many challenges remain to be done to improve the management of patients and avoid disabling sequelae.

Background and purpose: The thalamic infarct is frequent among ischemic stroke. We aim to determine the frequency of the thalamic infarct and analyze the different arterial territories affected in patients with thalamic syndrome. Patients and Methods: It was a prospective study. It focused on patients hospitalized in the neurology department of our university hospital, and covered the period from January to December, 2012. Only inpatients respondents to clinical and radiological criteria for diagnosis of thalamic ischemic stroke were included. All were evaluated with detailed clinical and neuropsychological evaluation, computer tomography scan (CT scan), routine blood studies, electrocardiogram, and transthoracic echocardiography. All standard risk factors were recorded in these patients. Results: A total of 768 files were analyzed of which 219 cases of cerebral infarction were selected. Among them, 12 patients had lesions involved only thalamic nuclei, which giving the frequency of 5.48%. The mean age was 59.33 years old with a ratio sex of 1.7. The clinical signs most observed were motor deficits (8/12), speech disturbances and anterograde memory impairment (7/12), and. sensory loss (5 cases). The high blood pressure was the main risk factor in all patients. The left thalamic ischemia was most frequent with 7/12 cases. The arterial territories affected were formed by the thalamotuberal arteries in 5/12, thalamoperforating arteries, (4/12), thalamogeniculate arteries, (3/12) and posterior choroidal arteries in 2/12, giving fourteen lesions. Conclusion: Thalamic infarct solely is not so rare and all its arterial branches may be affected. The sensory deficits and abnormal involuntary movement remain the embarrassing and difficult symptom to manage.