The value of cross-sectional imaging in evaluation of stroke patients

Abstract

Background: Due to poor availability of functional cross-sectional imaging in the developing countries, cerebrovascular accident (CVA) and its management has continued to be a major health problem. The need for cross-sectional imaging such as computed tomography (CT) of the brain for the exclusion of stroke mimics and for therapeutic decision cannot be overemphasized. Materials and Methods: This was a prospective case study conducted at the Federal Teaching Hospital, Gombe, from June 2016 to December 2016. One hundred and thirty patients who presented with clinical features and provisional diagnosis of CVA (also known as stroke) and were referred to the radiology department for brain CT were consecutively selected. A total of 111 had CT scan features of acute stroke, 6 had brain atrophy, 8 had intracranial space-occupying lesions, and 5 were normal brain scan. Data were analyzed using SPSS version 16.0 package. P ≤ 0.05 and a confidence interval of 95% were adapted for the statistical analysis. All comparisons of variables were done applying kappa statistical analysis. Results: There were 81 (62%) males and 49 (38%) females aged 18–80 years (mean ± standard deviation of 57.49 ± 13.47 years). About 15% (19) of the patients had a diagnosis other than stroke (stroke mimics). One hundred and eleven (85%) had a stroke, of which 94 (84.7%) were ischemic stroke, while the remaining 17 (15.3%) were hemorrhagic stroke. This study also found a discordance between clinical and CT diagnosis of stroke and stroke subtypes; κ = 0.289. Conclusion: The clinical diagnosis of stroke and stroke subtypes may not be reliable without neuroimaging, and the need for CT scan for proper evaluation of stroke patients is well justified.