This Article Full Text Full Text (PDF) All Versions of this Article: 36/5/960    most recent 01.STR.0000162585.97216.efv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kumwenda, J.J. Articles by Zijlstra, E.E. Search for Related Content PubMed PubMed Citation Articles by Kumwenda, J.J. Articles by Zijlstra, E.E. Related Collections Clinical Studies Cerebrovascular disease/stroke Acute Stroke Syndromes

(Stroke. 2005;36:960.)
© 2005 American Heart Association, Inc.

Original Contributions

Differential Diagnosis of Stroke in a Setting of High HIV Prevalence in Blantyre, Malawi

J.J. Kumwenda; G. Mateyu; S. Kampondeni; A.P. van Dam; L. van Lieshout E.E. Zijlstra

From the Department of Medicine (J.J.K., G.M., E.E.Z.), College of Medicine, Blantyre, Malawi; Department of Radiology (S.K.), Queen Elizabeth Central Hospital, Blantyre, Malawi; and Departments of Medical Microbiology (A.P.vD.) and Parasitology (L.vL.), Leiden University Medical Centre, Leiden, the Netherlands.

Correspondence to Professor E.E. Zijlstra, Department of Medicine, College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi. E-mail eezijlstra{at}malawi.net

Background and Purpose— The differential diagnosis of stroke in Africa in areas with high HIV prevalence includes brain infections. We studied causes of stroke in Blantyre, Malawi, where HIV prevalence among medical inpatients is 70%.

Methods— In a descriptive study of 8-month duration, all patients presenting at Queen Elizabeth Central Hospital, Blantyre, with central neurological deficit of acute onset (<24 hours) had baseline investigations, including full blood count, blood glucose, serology for toxoplasmosis, syphilis, and HIV, ECG, echocardiogram, ultrasound of the carotid arteries, and computerized tomography scan of the brain. A lumbar puncture was performed unless contraindicated.

Results— Ninety-eight consecutive patients (49 males) were studied. In those who were HIV positive (48%), the mean age was 37.5 years; ischemic stroke was the commonest diagnosis (n=25; 58%), followed by infection (n=11; 23%; including tuberculous [n=4] and cryptococcal [n=2] meningitis; toxoplasmic encephalitis [n=1]; neurocysticercosis [n=1]; brain abscess [n=1]; and progressive multifocal leucoencephalopathy [n=2]). No clinical or laboratory parameters could be identified as predictors for infection, but 3 of 5 patients with fever on admission had tuberculous meningitis. In HIV-negative patients (mean age 58.6 years), 55% had ischemic stroke and 31% had intracerebral hemorrhage; no brain infection was diagnosed. Presence of vascular disease correlated with age but not with HIV status.

Conclusions— Ischemic stroke was found in half of patients irrespective of HIV status. In those who are HIV positive, brain infection should be considered for which the presence of fever and examination of cerebrospinal fluid seem most useful in diagnosis.

Key Words: HIV • stroke