Gadama Yohane G, Mwangalika Gloria, Kinley Louis B, Jackson Beth, Mwandumba Henry C, Mallewa Jane, Solomon Tom, Simister Rob, Benjamin Laura A, Vargas Maria I, Kamtchum-Tatuene Joseph, Phiri Tamara
Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi.
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi.
Malawi Med J. 2017 Jun;29(2):189-193. doi: 10.4314/mmj.v29i2.21.
A 19-year-old man presented with a 1-year history of headache, generalised body weakness, progressive memory loss, and disorientation. One month prior to admission, there was aggravation of the weakness of the right upper limb, with new-onset difficulty with mastication, speech impairment, apathy, and urinary incontinence. On clinical examination, the patient had a motor aphasia and a right-sided hemiparesis with increased muscle tone and hyperreflexia. A noncontrast computed tomography (CT) scan of the brain revealed large ischaemic strokes extending beyond the classical vascular territories. Cerebrospinal fluid analysis showed a mildly increased protein level. The electrocardiogram revealed an irregular sinus bradycardia. The remainder of the cardiovascular and laboratory workup was unremarkable. Considering a working diagnosis of central nervous system vasculitis, the patient was treated with aspirin, prednisolone, and physiotherapy. However, he died suddenly a few weeks later. Based on this case, we discuss the challenges of stroke management in resource-limited settings, provide practical tips for general practitioners, reflect on the potential avenues for short- and long-term action, and introduce the budding collaboration platform between the University College London, the University of Liverpool, the Queen Elizabeth Central Hospital, and the Malawi-Liverpool-Wellcome Trust Clinical Research Programme.
一名19岁男性，有1年头痛、全身乏力、进行性记忆力减退和定向障碍病史。入院前1个月，右上肢无力加重，出现咀嚼困难、言语障碍、淡漠和尿失禁。临床检查发现患者存在运动性失语及右侧偏瘫，肌张力增高且反射亢进。脑部非增强计算机断层扫描（CT）显示大面积缺血性卒中，超出经典血管分布区域。脑脊液分析显示蛋白水平轻度升高。心电图显示窦性心动过缓且不规则。心血管及实验室检查的其余结果无异常。考虑中枢神经系统血管炎的初步诊断，给予患者阿司匹林、泼尼松龙治疗及物理治疗。然而，几周后他突然死亡。基于此病例，我们讨论资源有限环境下卒中管理的挑战，为全科医生提供实用建议，思考短期和长期行动的潜在途径，并介绍伦敦大学学院、利物浦大学、伊丽莎白女王中央医院和马拉维 - 利物浦 - 惠康信托临床研究项目之间新兴的合作平台。
