Challenges of stroke management in resource-limited settings: A case-based reflection|
Gadama, Yohane G.; Mwangalika, Gloria; Kinley, Louis B.; Jackson, Beth; Mwandumba, Henry C.; Mallewa, Jane; Solomon, Tom; Simister, Rob; Benjamin, Laura A.; Vargas, Maria I.; Kamtchum-Tatuene, Joseph & Phiri, Tamara
A 19-year-old man presented with a 1-year history of headache, generalised body weakness, progressive memory loss, and disorientation.
One month prior to admission, there was aggravation of the weakness of the right upper limb, with new-onset difficulty with
mastication, speech impairment, apathy, and urinary incontinence. On clinical examination, the patient had a motor aphasia and a right-sided
hemiparesis with increased muscle tone and hyperreflexia. A noncontrast computed tomography (CT) scan of the brain revealed
large ischaemic strokes extending beyond the classical vascular territories. Cerebrospinal fluid analysis showed a mildly increased protein
level. The electrocardiogram revealed an irregular sinus bradycardia. The remainder of the cardiovascular and laboratory workup was
unremarkable. Considering a working diagnosis of central nervous system vasculitis, the patient was treated with aspirin, prednisolone,
and physiotherapy. However, he died suddenly a few weeks later. Based on this case, we discuss the challenges of stroke management in
resource-limited settings, provide practical tips for general practitioners, reflect on the potential avenues for short- and long-term action,
and introduce the budding collaboration platform between the University College London, the University of Liverpool, the Queen
Elizabeth Central Hospital, and the Malawi–Liverpool–Wellcome Trust Clinical Research Programme.