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Scientific article
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Challenges of stroke management in resource-limited settings: A case-based reflection

Published inMalawi Medical Journal, vol. 29, no. 2, p. 189-193
Publication date2017
Abstract

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 rightsided 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.

Keywords
  • Stroke
  • Vasculitis
  • CT
  • MRI
Citation (ISO format)
GADAMA, Yohane G et al. Challenges of stroke management in resource-limited settings: A case-based reflection. In: Malawi Medical Journal, 2017, vol. 29, n° 2, p. 189–193. doi: 10.4314/mmj.v29i2.21
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Article (Published version)
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ISSN of the journal1995-7262
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