Pathological sub-types, risk factors and outcome of stroke at the Nairobi Hospital, Kenya.

BACKGROUND

Stroke is one of the most common causes of morbidity and mortality the world over. Established risk factors such as arterial hypertension, diabetes mellitus, cigarette smoking, hyper-lipidaemia, micro-vascular rupture, male gender, age and observed co-morbities such as sickle cell disease, HIV/AIDS infection and cerebral malaria are increasingly being encountered in the tropics.

OBJECTIVES

To determine pathological sub-types, risk factors, in-hospital period prevalence and in-hospital outcome of stroke.

DESIGN

Hospital-based retrospective study.

SETTING

The Nairobi Hospital, Nairobi, Kenya.

SUBJECTS: Patients with recorded diagnosis of stroke/cerebral vascular accident; as per WHO criteria for diagnosis of stroke, all gender and age > or = 18 years were studied.

RESULTS

A total of 2629 patients were admitted to the division of medicine at the hospital during study period. Eighty patients had diagnosis of stroke; giving an in-hospital period prevalence of 3042/100,000. Mean age was 61.3 years, mode; 63 years, range 34-95 years. Males were 43 (53.8%), M to F ratio 1.2:1 stroke sub-types: Ischaemic stroke 68 (85%), haemorrhagic stroke seven (8.8%). In five patients (6.3%) no evidence of stroke sub-type was on-record. Established risk factors for stroke included hypertension and diabetes mellitus. Hypertension was found in 64 patients (80%) and diabetes-mellitus in 27 (33.7%). Twenty three patients (28.8%) had both hypertension and diabetes-mellitus. Co-morbidities were observed and included mitral-stenosis, cardiac-arrhythmias cardio-myopathy, HIV/AIDS, Left Ventricular Hypertrophy (LVH), infective endocarditis, atrial septal aneurysm, carotid plaques with or without stenosis and hyper-homocystenemia. Mean hospital stay was 12.5 days; range 22-70 days. Seventy five patients (93.8%) were discharged and four (5%) died in hospital. All patients who died had anterior circulation ischaemic stroke as per Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification.

CONCLUSION

Ischaemic stroke is the most common pathological sub-type observed in this study. Hypertension is the leading observed risk factor for stroke. Hospital period prevalence for stroke of 3042/100,000 was found. Seventy five patients (93.8%) were discharged and four (5%) died in hospital.