Concurrent Occurrence of Ischemic and Hemorrhagic Stroke in a Patient in a Low Resource Setting Hospital, Western...

The concurrent occurrence of ischemic and hemorrhagic stroke in different anatomical regions of the brain is a rare but clinically significant phenomenon. Traditionally, stroke is classified into ischemic or hemorrhagic subtypes based on distinct pathophysiological mechanisms. Ischemic stroke results from cerebral arterial occlusion leading to tissue infarction, while hemorrhagic stroke is caused by rupture of cerebral vessels with extravasation of blood into brain parenchyma or surrounding spaces. The simultaneous presence of both stroke subtypes challenges this dichotomous classification and presents diagnostic as well as therapeutic dilemmas. Available epidemiological data suggest that the vast majority of stroke cases present as a single pathological subtype. We present a case of an elderly lady known hypertensive on treatment with no known history of prior stroke that presented with sudden onset focal neurological deficits for 3 days, depressed level of consciousness. Non contrasted CT scan of the brain showed concurrent ischemic and hemorrhagic strokes in two different areas. Management was only supportive with definitive management impossible due to the dilemma of thrombolysis use in such a case which was also not available at the facility. The poor outcome was compounded by dilemma in management and financial constraints with patient being discharged on request of attendants to home care with only mild improvement in the focal neurological deficits and depressed level of consciousness.

The diagnostic and therapeutic dilemma experienced in cases of concurrent ischemic and hemorrhagic stroke are compounded in low resource settings by late presentation, inadequate diagnostic measures and limited management options thus the poorer outcome in an already complicated medical dilemma.