Stroke

David Mabey: Affiliation:
London School of Hygiene and Tropical Medicine
Martin W. Weber: Affiliation:
World Health Organization
Moffat Nyirenda: Affiliation:
London School of Hygiene and Tropical Medicine
Dorothy Yeboah-Manu: Affiliation:
Noguchi Memorial Institute for Medical Research, University of Ghana
Jackson Orem: Affiliation:
Uganda Cancer Institute, Kampala
Laura Benjamin: Affiliation:
University College London
Michael Marks: Affiliation:
London School of Hygiene and Tropical Medicine
Nicholas A. Feasey: Affiliation:
Liverpool School of Tropical Medicine

Book contents

Get access

Summary

Increasing population age and vascular risk factors in Africa are causing an increased burden of stroke and stroke-related disability and mortality. There are three pathological stroke types: ischaemic stroke, cerebral haemorrhage and subarachnoid haemorrhage. Each stroke type results from specific causes and risk factors or combinations of risk factors, and their treatment differs. However, while subarachnoid haemorrhage is usually readily distinguishable from the other two types (Al Shahi et al. 2006), it is not easy to distinguish ischaemic stroke and cerebral haemorrhage without brain imaging. This highlights one of the key challenges to managing stroke in Africa, where very few patients have access to brain imaging. Local resources influence stroke management in Africa, but basic principles of stroke care are as important in low- as they are in high-resourced settings.

Information

Type: Chapter
Information: Principles of Medicine in Africa , pp. 642 - 650

DOI: https://doi.org/10.1017/9781009052733.069 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2025

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Akinyemi, RO, Ovbiagele, B, Adeniji, OA et al. (2021). Stroke in Africa: profile, progress, prospects and priorities. Nat Rev Neurol; 17(10): 634–56.10.1038/s41582-021-00542-4CrossRef Google Scholar PubMed

Al Shahi, R, White, PM, Davenport, RJ, Lindsay, KW (2006). Subarachnoid haemorrhage. Br Med J; 333: 235–40.Google Scholar PubMed

Amarenco, P (2020). Transient ischaemic attack. N Eng J Med; 20 (382):1933–41.Google Scholar

Benjamin, LA, Corbett, EL, Connor, MD et al. (2016). HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults: a case-control study. Neurology; 86(4): 324–33.10.1212/WNL.0000000000002278CrossRef Google Scholar PubMed

Bryer, A, Connor, M, Haug, P et al. (2010). South African guideline for management of ischaemic stroke and transient ischaemic attack 2010: a guideline from the South African Stroke Society (SASS) and the SASS Writing Committee. South African Med J; 100: 747–78.10.7196/SAMJ.4422CrossRef Google Scholar PubMed

Dennis, M, Sandercock, P, Reid, J, Graham, C, Forbes, J, Murray, G (2013). CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration: effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial. Lancet; 382: 516–24.Google Scholar

Hankey, GJ (2010). Ischaemic stroke – prevention is better than cure. J Roy Coll Phys Edin; 40: 56–63.10.4997/JRCPE.2010.111CrossRef Google Scholar PubMed

Huang, W-Y et al. (2021). Atrial fibrillation trial to evaluate real-world procedures for their utility in helping to lower stroke events: a randomized clinical trial. Int J Stroke; 16: 300–10.10.1177/1747493020938297CrossRef Google Scholar PubMed

Kumwenda, JJ, Mateyu, G, Kampondeni, S et al. (2005). Differential diagnosis of stroke in a setting of high HIV prevalence in Blantyre, Malawi. Stroke; 36: 960–4.10.1161/01.STR.0000162585.97216.efCrossRef Google Scholar

Lewando-Hundt, G, Stuttaford, M, Ngoma, B (2004). The social diagnostics of stroke-like symptoms: healers, doctors and prophets in Agincourt, Limpopo Province, South Africa. J Biosoc Sci; 36: 433–43.Google Scholar

Ma L, Hu X, Song L, Chen X, Ouyang M, Billot L et al. (2023). The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3): an international, stepped wedge cluster randomised controlled trial. The Lancet; 402 (10395): 27–40.Google Scholar

Pandian JD, Kalkonde Y, Sebastain IA, Felix C, Urimubenshi G, Bosch J (2020). Stroke systems of care in low-income and middle-income countries: challenges and opportunities. The Lancet; 396 (10260): 1443–1451.Google Scholar

RESTART Collaboration (2019). Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial. Lancet; 393: 2613–2623. doi: 10.1016/S0140-6736(19)30840-2.CrossRef Google Scholar

Steinmetz et al. (2024). Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol; 23: 344–81. doi.org/10.1016/S1474-4422(24)00038-3.Google Scholar

Urimubenshi, G, Cadilhac, DA, Kagwiza, JN, Wu, O, Langhorne, P (2018). Stroke care in Africa: a systematic review of the literature. Int J Stroke; 13(8):797–805.10.1177/1747493018772747CrossRef Google Scholar

Walker, RW, McLarty, DG, Masuki, G et al. (2000). Age specific prevalence of impairment and disability relating to hemiplegic stroke in the Hai District of northern Tanzania. J Neurol Neurosurg Psychiatry; 68: 749.10.1136/jnnp.68.6.744CrossRef Google Scholar

Warlow, C, van Gijn, J, Dennis, M et al. (2008). Stroke: Practical Management. Oxford: Blackwell.10.1002/9780470696361CrossRef Google Scholar

Accessibility standard: Unknown

Accessibility compliance for the PDF of this book is currently unknown and may be updated in the future.

Book contents

Chapter 68 - Stroke