Stroke at Kenyatta National Hospital-Spectrum of Imaging Findings, and the Average Time to Initial Neuroimaging

Abstract

Background Varying proportions of stroke subtypes are reported in literature. The most common reported in Kenya is ischemic stroke, ranging 52-85% on CT. Additionally, poor stroke functional outcomes and high mortality rates have been documented. No local studies have examined the time delays stroke patients experience before receiving care. Objective To describe the spectrum of cranial CT findings in patients presenting for imaging with a clinical suspicion of stroke, to estimate the average time between symptom onset to initial imaging and investigate the 60-day outcomes of ischemic stroke. Materials and methods The study was prospectively conducted at Kenyatta National Hospital from November, 2017 to April, 2018. Consecutive 106 patients with clinical suspicion of stroke referred for imaging were recruited. CT scans were acquired as per the institutional protocol. Clinical and radiological follow up after 60 days were carried in the subgroup of patients who had ischemic stroke. Results Stroke accounted for 42.4% of all findings, the majority being ischemic stroke (55.6%). Stroke mimics were seen in 18% of patients. The mean time to imaging was 70.8 hours, with none of the patients being eligible for thrombolysis. The 60-day ischaemic stroke outcomes showed predominant neurological deficits of residual limb weakness (48%) and recurring convulsions (16%). The mortality and symptomatic improvement in this subgroup were similar at 8%. Conclusion Cerebral infarction was the commonest stroke subtype. There was a greater percentage of stroke mimics such as intracranial masses and infections. The mean time from symptom onset to imaging was long, with none of the patients receiving thrombolytic therapy. The 60-day outcomes in the ischemic stroke subgroup was poor.