The burden of stroke in young black population and the role of post mortem evaluation in increasing awareness and prevention

Background: Stroke is the second commonest cause of preventable death and adult disability worldwide. While the risk factors, burden and mortality of stroke are known to a considerable extent in the older populations, the same still remain a big challenge in young population particularly in young black population, Rwanda included. Sometimes, stroke events in children and young adults happening without the existence of any of the known risk factors and as a result, clinicians tend to overlook the diagnosis of stroke in this particular age group. This case report aims to highlight the existing burden of stroke as well as create awareness for prevention, timely recognition and proper diagnosis of stroke in young black subjects.
Methods: We review two cases autopsied at the Kacyiru Police Hospital, Kigali-Rwanda, in 2015 in which a definitive diagnosis was not clearly established prior to death. These cases were presented at the 4th Interdisciplinary Forensic Summer School with the leading theme “A holistic approach towards a safer society” held in Kigali-Rwanda from 24th-27th August 2015.
Results: Following autopsy, hemorrhagic stroke was confirmed in two cases involving young patients aged 16 and 17 years respectively. Antemortem diagnoses did not include stroke.
Conclusion: These case reports clearly highlight the existing burden of stroke in young subjects, and with limited diagnostic modalities evident in low-income countries, emphasis needs to be put on risk-factor screening and prevention. Furthermore, stroke events in children and young adults happen without the existence of any of the known risk factors and so, there is a tendency to overlook the diagnosis of stroke in this particular age