Cerebrovascular Accidents in Sana'a City, Yemen: Clinico-Epidemiologic and Neuroimaging Findings

Abstract

Background: Cerebrovascular accidents (CVA) are acute neurologic injuries that represent a common cause of disability and mortality worldwide, with ischemic and hemorrhagic strokes being the most common forms. In Yemen, there has been limited research on CVA. Therefore, this study aimed to determine the clinical presentation, risk factors and different types of CVA based on head computed tomography (CT) scans among patients admitted to tertiary care hospitals in Sana'a. Methods: A descriptive cross-sectional study was conducted among 201 patients with CVA who underwent head CT scans at four tertiary hospitals in Sana'a from October 2023 to February 2024. Data about sociodemographic characteristics, clinical presentation and potential risk factors for CVA were collected using a questionnaire. Descriptive statistics were then used to summarize and present the data. Results: Most patients with CVA admitted to tertiary care hospitals were males (63.7%) and over 40 years old (81%), with a mean age of 56 ± 17 years. More than half of the patients were rural residents (56.7%), illiterate (57.2%), and unemployed (55.2%). Based on CT scan findings, 68.7% (138/201) of patients with CVA had ischemic strokes and 15.4% (31/201) had hemorrhagic strokes. However, the pattern of CVA was undetermined in 15.9% (32/201) of patients. Dysarthria (49.3%) was the most frequent presentation among patients with CVA, followed by left-sided hemiplegia (39.8%), headache (32.8%), right-sided hemiplegia (30.8%), and choking (30.3%). In contrast, fatigue and loss of vision were the least frequent presentations (0.5% each), followed by asphyxia (2.5%), diplopia (3%), chest pain (4.5%), and coma (5.5%). Other manifestations ranged from 7% for memory loss to 28.9% for decreased consciousness. Khat chewing was the most frequent potential risk factor among 64.2% of stroke patients, followed by HTN (46.8%), smoking (39.8%), DM (33.3%), and past history of stroke (23.4%). However, dyslipidemia (8.4%) and family history of stroke (15.9%) were the least frequent potential risk factors among stroke patients. Conclusion: Approximately two-thirds of patients admitted with CVA to tertiary care hospitals in Sana’a experience ischemic strokes in alignment with the global trends in CVA epidemiology. Clinical presentations in CVA patients vary, with dysarthria and hemiplegia being the most predominant. The high frequency of khat chewing and smoking as potential risk factors emphasizes the necessity of public health interventions to reduce these habits. Likewise, hypertension and diabetes mellitus are common potential risk factors that call for improving healthcare services to control these chronic diseases and lower the risk of CVA.