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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
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Published in Malawi Medical Journal. 2017, vol. 29, no. 2, p. 189-193
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 StrokeVasculitisCTMRI
PMID: 28955431
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Article (Published version) (618 Kb) - public document Free access
Research group Optimisations des techniques avancés en neuroimagerie (985)
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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. https://archive-ouverte.unige.ch/unige:97690

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Deposited on : 2017-10-17

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