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This case report aims to highlight the occurrence and management challenges of concurrent ischemic and hemorrhagic strokes in a low resource setting.

May 25, 2026International Medical Case Reports Journal0 citationsOpen Access

Concurrent Occurrence of Ischemic and Hemorrhagic Stroke in a Patient in a Low Resource Setting Hospital, Western Uganda: A Case Report

HNHildah Nalumansi KBKusemererwa Byaruhanga TKThomas Kwesiga

Key Points

This case report aims to highlight the occurrence and management challenges of concurrent ischemic and hemorrhagic strokes in a low resource setting.
Case presentation of an elderly hypertensive woman with sudden onset neurological deficits and depressed consciousness.
Non-contrasted CT scan analysis revealed both ischemic and hemorrhagic strokes in different brain regions.
Supportive management was provided due to constraints in definitive treatment options.
Patient had concurrent ischemic stroke and hemorrhagic stroke as seen on CT scan.
Supportive management led to mild improvement in neurological deficits but poor overall outcome.
Diagnosis and treatment dilemmas were exacerbated by financial constraints and lack of advanced medical resources.

Abstract

Background: 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. Conclusion: 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. Keywords: ischemic stroke, hemorrhagic stroke, hypertension

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