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

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Gadama, Yohane G, Mwangalika, Gloria, Kinley, Louis B, Jackson, Beth, Mwandumba, Henry, Mallewa, Jane, Solomon, Tom, Simister, Rob, Benjamin, Laura A, Vargas, Maria I, Kamtchum-Tatuene, Joseph and Phiri, Tamara (2017) 'Challenges of stroke management in resource-limited settings: A case-based reflection.'. Malawi medical journal : the journal of Medical Association of Malawi, Vol 29, Issue 2, pp. 189-193.

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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 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.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WL Nervous System > WL 300 General works (Include works on brain alone)
Faculty: Department: Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI): https://doi.org/10.4314/mmj.v29i2.21
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 27 Oct 2017 15:59
Last Modified: 30 Jan 2018 16:43
URI: http://archive.lstmed.ac.uk/id/eprint/7675

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