Correlation between clinical and cranial computed tomography findings of stroke patients at selected centers in Kampala, Uganda

Abstract

Background: A stroke or cerebrovascular accident is defined as an abrupt onset of a neurologic deficit that is attributable to a vascular cause. In developing countries like Uganda, the burden of stroke is growing and causing significant morbidity and disability with high mortality rates. However, there is limited data on this subject especially regarding clinical and imaging findings. Neuroimaging is required to differentiate ischemic stroke from intracerebral hemorrhage, as well as to diagnose entities other than stroke. Therefore, understanding the clinico-demographic features and cranial Computed Tomography (CT) findings of stroke as well as their correlation is of utmost value in stroke management. Objective: To determine the clinical and cranial CT scan findings of stroke patients attending selected centers in Kampala. Methods: This was a cross-sectional study of 270 clinically suspected stroke patients at selected centers in Kampala. Patients with neurologic deficit due to trauma, known intracranial neoplasm or suspected substance abuse were excluded. Using a structured questionnaire, data on the clinical-demographic and cranial CT findings was collected, entered into REDCap software and then analyzed with STATA 16 Software. The findings were evaluated, tabulated independently and subsequently correlated with the clinical findings from the available patients’ records. Results: Of the 270 study participants, 141 (52.2%) were male, 162(60%) had CT findings of stroke, 90(33.3%) had normal cranial CT findings. While 18(6.7%) had other CT findings like tumor, Dural hemorrhage, epidermoid cyst and others. The ischemic stroke, hemorrhagic stroke and subarachnoid hemorrhage accounted for 124(45.9%), 34(12.6%) and 4(1.5%) respectively. Limb weakness (55.2%), Headache (41.1%) and loss of consciousness (39.3%) were associated with stroke findings on CT. Among the acute ischemic strokes, 30(73.2%) had a worse (0-7) ASPECT score. Those aged ≥65 years were associated with a worse ASPECTS [AOR: 22.01, (95%CI: 1.58-306.09) p-value =0.021]. Conclusion: Non-contrasted cranial computerized Tomography is still the gold standard for diagnosis to differentiate the stroke types, patient management, treatment and timely referral to a stroke center. The clinical diagnosis of stroke is inadequate to exclude other stroke mimics. Hypertension and advanced age are the most prevailing risk factors attributed to both ischemic and hemorrhagic stroke and patients over 65 years were associated with a worse ASPECT score.