Association Between Clinical Signs and Brain Computed Tomography Findings in Patients with Suspected Stroke at the University Clinics of Kinshasa

Abstract

Introduction

Stroke is a leading cause of mortality and long-term disability worldwide, particularly in low- and middle-income countries. Accurate differentiation between ischaemic stroke, haemorrhagic stroke, and stroke mimics is essential for appropriate management. In resource-limited settings, non-contrast brain computed tomography (CT) remains the primary imaging modality for confirming the diagnosis and guiding treatment decisions.

Purpose

To describe the clinical and brain CT characteristics of patients with suspected stroke and assess the association between clinical findings and CT-confirmed stroke at the University Clinics of Kinshasa.

Methods

A hospital-based descriptive and analytical cross-sectional study was conducted at the University Clinics of Kinshasa, Democratic Republic of the Congo, from January to June 2024. All eligible patients referred for brain CT because of clinically suspected stroke were consecutively enrolled. Sociodemographic, clinical, and comorbidity data were collected from medical records. Brain CT findings were classified as ischaemic stroke, haemorrhagic stroke, normal findings, or stroke mimics. Data were analysed using Stata/MP 17.0. Logistic regression was used to identify factors associated with CT-confirmed stroke.

Results

A total of 567 patients were included, with a mean age of 61.5 ± 14.2 years; 52.9% were male. Brain CT confirmed stroke in 336 patients (59.3%), while 81 (14.3%) had normal CT findings and 150 (26.4%) had stroke mimics. Among CT-confirmed strokes, 261 (77.7%) were ischemic and 75 (22.3%) were hemorrhagic. The most common clinical manifestations were limb motor deficit (64.4%), altered consciousness (58.7%), and headache (23.5%), whereas hypertension (81.7%) was the predominant comorbidity. In multivariable analysis, limb motor deficit (aOR = 1.73, 95% CI: 1.17–2.56; p = .006), language impairment (aOR = 2.52, 95% CI: 1.19–5.33; p = .016), and hypertension (aOR = 2.20, 95% CI: 1.41–3.43; p < .001) were independently associated with CT-confirmed stroke, whereas age ≥65 years was associated with lower odds of CT-confirmed stroke (aOR = 0.50, 95% CI: 0.33–0.75; p < .001).

Conclusion

Approximately two-fifths of patients clinically suspected of stroke did not have CT-confirmed stroke, highlighting the limitations of clinical assessment alone. Ischaemic stroke was the predominant subtype, and specific clinical features were significantly associated with CT-confirmed stroke. These findings reinforce the importance of brain CT for accurate diagnosis and differentiation of stroke subtypes in resource-limited settings.