Stroke services in the Middle East and adjacent region: A survey of 34 hospital-based stroke services.

Background: Acute stroke care is complex and requires multidisciplinary networking. There are insufficient data on stroke care in the Middle East and adjacent regions in Asia and Africa. Objective: Evaluate the state of readiness of stroke programs in the Middle East North Africa and surrounding regions (MENA+) to treat acute stroke. Method: Online questionnaire survey on the evaluation of stroke care across hospitals of MENA+ region between April 2021 and January 2022. Results: The survey was completed by 34/50 (68%) hospitals. The median population serviced by participating hospitals was 2 million. The median admission of patients with stroke/year was 600 (250-1,100). The median length of stay at the stroke units was 5 days. 34/34 (100%) of these hospitals have 24/7 CT head available. 17/34 (50%) have emergency guidelines for prehospital acute stroke care. Mechanical thrombectomy with/without IVT was available in 24/34 (70.6%). 51% was the median (IQR; 15-75%) of patients treated with IVT within 60 min from arrival. Thirty-five minutes were the median time to reverse warfarin-associated ICH. Conclusion: This is the first large study on the availability of resources for the management of acute stroke in the MENA+ region. We noted the disparity in stroke care between high-income and low-income countries. Concerted efforts are required to improve stroke care in low-income countries. Accreditation of stroke programs in the region will be helpful.

Relationship between white-matter hyperintensities and hematoma volume and growth in patients with intracerebral hemorrhage.

BACKGROUND AND PURPOSE: The presence of white-matter hyperintensities (WMHs) has been linked to intracerebral hemorrhage (ICH). We sought to determine whether the severity of WMHs influences hematoma growth and ICH volume. METHODS: We retrospectively reviewed prospectively collected clinical, laboratory, and radiologic data from 79 consecutive ICH patients who had brain magnetic resonance imaging performed within 72 hours of ICH symptom onset. We assessed the severity of WMHs on magnetic resonance imaging on the modified Scheltens scale and performed logistic-regression analysis to examine the association between WMHs and ICH volume. We also examined the association between WMH score and hematoma growth in a subset of 34 patients who had a baseline computed tomography scan within 12 hours of ICH onset and a follow-up scan within 72 hours. RESULTS: The ICH volume at 37.6+/-22.3 hours from ICH onset was 2-fold higher in patients with a high WMH score (> or =14) than in those with a lower score. A high WMH score was independently associated with a larger ICH volume (odds ratio=1.152; 95% CI, 1.035 to 1.282; P=0.01). There was a trend for an association between WMH score and ICH volume growth (odds ratio=1.286; 95% CI, 0.978 to 1.692; P=0.062). CONCLUSIONS: Severe WMHs are associated with larger ICH volumes and, to a lesser extent, with hematoma growth. Our findings suggest that WMHs may provide important prognostic information on patients with ICH and may have implications for treatment stratification. These findings require prospective validation, and the links between WMHs and ICH growth require further investigations.