Cerebral dominace and side of stroke among patients attending Neuro-Clinics in Uganda: A cross sectional study of Mulago and Kirudu National Referral Hospitals

Abstract

Introduction: Non-dominant hemispheric strokes have been associated with more severe stroke, longer recovery time and much slower return of functional activity compared to the dominant side. During activity Functional MRI studies have demonstrated increased blood supply to the dominant cerebral hemisphere compared to the non-dominant. Comparatively the dominant cerebral hemisphere is exponentially active in activities of daily life perhaps yielding vascular adaptability, plasticity that could be protective against stroke. Modifying or enhancing non dominant handedness could be used in preventing stroke or reducing its severity. Objectives. To establish the relationship between cerebral dominance (handedness) and side affected by stroke among stroke patients attending Mulago and Kiruddu national referral hospitals in Uganda Methodology: This was a cross sectional study involving 128 stroke patients aged 18years and above attending neuro clinics and wards at Mulago and Kiruddu National Referral Hospitals and had provided written informed consent. Unconscious patients, those with TIAs and stroke resulting from non-vascular causes were excluded from the study. Data sources included researcher assisted questionnaires, modified Edinburgh handedness assessment tool and radiological investigation of brain CT- scan. Data was entered in Excel and exported to STATA for analysis. Odds ratios were used to determine the association between stroke and side affected by stroke. p values <0.005 were considered statistically significant. Results A total of 133 adult patients were enrolled in this study. Out of the 133 participants, 77 participants (57.9%) were females and the mean was 59.9 (S.D 1.29) years. Most of the participants (60.9%) reported no history of routine exercises. Majority of the participants (93.94%) were hypertensive were while only 18.9 were suffering from diabetes mellitus. 124 (93.23%) were right handed/ left cerebral dominant and 9 (6.77%) were left handed/right cerebral dominant. The middle cerebral artery was the most prevalent artery affected by stroke (93.24%). Majority of the participants (74.4%) presented with ischemic stroke. There was a significant association between side of stroke and the non-dominant cerebral hemisphere or handedness (p=0.001). Conclusion Side affected by Stroke is related to the non-dominant side/ cerebral hemisphere in Uganda. Affirmative exercises and activities of daily living for the non-dominant laterality needs to be encouraged in individuals at risk for developing stroke in Uganda