First documented case of thrombolysis in a teaching hospital in Ghana: challenges to early intervention in acute infarctive stroke in developing countries

Abstract

Background We report a case of an elderly woman who developed an Ischemic stroke. Thrombolytic therapy was successful as evidenced by functional and neurological improvement. This is the first well-documented case of such intervention in Korle-Bu Teaching Hospital (KBTH), Stroke unit. Case Information: Our patient is a 64-year-old woman who is known to have hypertension and diabetes. She had been relatively well until she developed an ischemic stroke. Five days prior to this, she had experienced two episodes of Transient Ischemic Attacks (TIA). Thrombolytic therapy was successful with Tenecteplase given at 4.5 hours post-episode. MRS (Modified Ranking Scale) and NHISS (National Health Institute of Stroke Scale) pre thrombolysis were 4 and 10 respectively. NHISS 2hrs post thrombolysis was 4. MRS and NHISS 24hrs post thrombolysis were 0 and 1 respectively. We sought to identify why only a few cases of thrombolytic therapies are carried out in developing countries, and we found that the strict eligibility for the initiation of therapy was the main barrier. Conclusion In acute infarctive stroke management, intervention is time-dependent, as thrombolysis has been shown to prevent permanent disability if instituted early enough. We believe that many more individuals may benefit from thrombolytic therapy if more studies are carried out with systematic reviews of case reports and research, factoring in key challenges met in middle to low-income countries.