The Prevalence and Characteristics of Embolic Stroke of Undetermined Source Among Sudanese Patients From November 2019 to March 2020: A Cross‐Section Study

TL;DR

This study found that Sudanese patients with undetermined stroke source (ESUS) were younger and more often female compared to those with known stroke causes.

Contribution

The study provides the first insights into ESUS characteristics in Sudanese stroke patients.

Findings

ESUS patients were significantly younger and had more female predominance compared to SDS patients.

Normal echocardiography and carotid ultrasound findings were more common in the ESUS group.

Female gender and normal diagnostic test results were significant predictors of ESUS.

Abstract

To study the prevalence and characteristics of embolic stroke of undetermined source (ESUS) among Sudanese patients.

This cross‐sectional study included 70 patients with recent ischemic strokes at the National Center for Neurological Sciences of Ibrahim Malik Hospital and Omdurman Teaching Hospital in Khartoum from November 2019 to March 2020. Characteristics of ESUS patients were analyzed and compared with stroke of determined source (SDS) patients. Demographics were analyzed, alongside clinical history. Imaging findings from computed tomography (CT) scans, carotid Doppler ultrasound, and echocardiographic evaluations were also assessed.

There were 18 (25.7%) cases in ESUS group and 52 (74.3%) cases in SDS group. ESUS group was significantly younger (44.3 ± 9.9 vs. 62.3 ± 17.7 years; p value < 0.001) with female predominance (66.7% vs. 46.2%; p value = 0.001) than SDS group. Risk factors such as hypertension (44.2%) and diabetes mellitus (DM) (35.6%) were prevalent in the SDS group. In electrocardiography (ECG) findings, left ventricular hypertrophy (LVH) (ESUS = 16.7% vs. SDS = 7.7%) and bradycardia (ESUS = 5.6% vs. SDS = 0%) were common among ESUS patients, while, atrial fibrillation (AF) (ESUS = 0% vs. SDS = 15.4%), ischemic changes (ESUS = 11.1% vs. SDS = 32.7%), and left bundle branch block (LBBB) (ESUS = 0% vs. SDS = 7.7%) were common among SDS patients. Normal echocardiography (64.7% vs. 17.3%; p value = 0.003) as well as carotid ultrasonography (US) findings (61.1% vs. 36.5%; p value = 0.002) were more prevalent in the ESUS group than in the SDS group. Multivariate analysis identified female gender (OR = 2.33; 95% CI: 1.76–7.16; p value = 0.016), normal findings on echocardiography (OR = 8.19; 95% CI: 2.76–24.32; p value 0.003), normal carotid Doppler ultrasound (OR = 5.0; 95% CI: 1.87–32.7; p value = 0.023), and normal ECG findings (OR = 3.5; 95% CI: 1.17–10.44; p value = 0.036) as significant predictors of ESUS.

The study underscores significant differences between ESUS and SDS patients, highlighting the need for tailored clinical approaches based on stroke classification.

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