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

• DOI: 10.4314/mmj.v29i2.21
• Publication Date: 2017-08-23T14:24:34Z
• Authors: Yohane G. Gadama; Gloria Mwangalika; Louis B. Kinley; Beth Jackson; Henry C. Mwandumba; Jane Mallewa; Tom Solomon; Rob Simister; Laura A. Benjamin; Maria I. Vargas; Joseph Kamtchum-T...; Tamara Phiri
• Keywords: Reflection; Stroke

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 the weakness right upper limb, new-onset difficulty mastication, speech impairment, apathy, urinary incontinence. On clinical examination, patient had motor aphasia right-sided hemiparesis increased muscle tone hyperreflexia. noncontrast computed tomography (CT) scan brain revealed large ischaemic strokes extending beyond classical vascular territories. Cerebrospinal fluid analysis showed mildly protein level. The electrocardiogram an irregular sinus bradycardia. remainder cardiovascular laboratory workup unremarkable. Considering working diagnosis central nervous system vasculitis, treated aspirin, prednisolone, physiotherapy. However, he died suddenly few weeks later. Based on this case, we discuss challenges stroke management in resource-limited settings, provide practical tips for general practitioners, reflect potential avenues short- long-term action, introduce budding collaboration platform between University College London, Liverpool, Queen Elizabeth Central Hospital, Malawi-Liverpool-Wellcome Trust Clinical Research Programme.