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.
Please, tell me about your personal and professional background. PDK: I was born and raised in Thyolo District, in the tea estates. My mother was a nurse and my father was an agriculture officer, working in the tea estates. I started my primary school when I was 4 years old, quite an early age in those days. I had a smooth running of my primary school until Standard 8 where I stalled a bit, but not worrying as it was a norm those days in my area that one would re-sit standard 8 exams multiple times before they could get selected to a government secondary school. In my case, I had 3 attempts and got selected to Kamuzu Academy in 1989. At Kamuzu Academy, I studied sciences and languages like Greek and Latin. In 1995, I started my medical training at College of Medicine and graduated in 2000. After finishing my medical training, I started internship at Queen Elizabeth Central Hospital (QECH) in 2001. My internship did not go smoothly as in 2001, there was a strike at QECH and, somehow, I got involved which delayed my internship-I finished in 2003 at Kamuzu Central Hospital in Lilongwe. Then, I joined Malawi Blood Transfusion where I worked for 6 months before joining Mwaiwathu Private Hospital as a general practitioner. From Mwaiwathu, I joined College of Medicine before going to South Africa for my training in Neurosurgery YG: What motivated you to do neurosurgery? PDK: I must mention that while at College of Medicine as a student, I never saw myself standing in theatre for more than 4 hours doing an operation. From this, it would be obvious that Neurosurgery was not top on the list of things I wished to do then, but there was Professor Adeloye, a neurosurgeon, who inspired me. Life circumstances also played a profound role in me developing an interest to pursue neurosurgery. Our son was born preterm and developed hydrocephalus, and the experience I had during the management of his condition moved me to finally go into neurosurgery. I also owe Professor Nyengo Mkandawire a lot, because he encouraged and helped me to get a position at College of Medicine in the Surgery department and eventually facilitated my scholarship to study neurosurgery
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