Pathological Sub Types and Diagnostic Protocols of Stroke among Adult Patients Admitted to Jimma University Medical Center, South West Ethiopia

Background: In the modern approach in treating patients with strokes requires early Computed Tomography (CT) scan as it is imperative to diagnose whether the stroke is ischemic or hemorrhagic. Clinical diagnosis of stroke does not always correlate with imaging; this is even worse when narrowed to clinical diagnosis of specific stroke subtype, creating a high potential for patient morbidity and mortality. Patients and methods: Prospective observational study was carried at stroke unit of Jimma University Medical Center from March 10-July 10, 2017. Result: Of the total 116 patients, 61 patients (52.6%) had CT scan of the brain performed, whereas the remaining (47.4 %) of patients were evaluated clinically alone to have stroke. Using World health organization (WHO) criteria, 51.7% patients had ischemic stroke while 48.3% had hemorrhagic, with Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH) accounting for 44.0% and 4.3%, respectively. The median time to perform CT scan after hospital arrival was 4 days. The most common site of lesion of brain of hemorrhage stroke patients was basal ganglia (48.4%) followed by parietal lobe (29.0%) and ventricular (29.0%). The most common site of brain infarct was parietal lobe (33.3%) and cortical (33.3%), followed by basal ganglia (23.3%) and caudate nucleus (20.0%). On CT scan majority of hemorrhagic and ischemic stroke patients had Intraparenchymal Bleed (IPB) only (61.3%) and right hemisphere involvement (26.7%) respectively. The predominant stroke etiology as Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria was undetermined etiology, 26 (43.3%), mainly because of incomplete evaluation. Conclusion: Etiologic investigation for stroke was infrequently performed by the lack of systematic cardiological examinations and brain imaging, most of the time for financial reasons and unavailability of the instruments. It is therefore, pertinent that CT scan/ MRI should be incorporated in stroke diagnosis and management where possible.