Diagnostic and Therapeutic Gaps in Recurrent Stroke Management: Real-World Insights from a Ghanaian Hospital-based Registry.

Background Recurrent strokes account for up to 1 out of 4 strokes in Low-and-Middle-Income-Countries (LMICs), culminating in worsening of outcomes. International guidelines recommend subtype-specific etiological workup to help tailor strategies for prevention of recurrence after an index stroke. However, huge gaps in secondary stroke prevention persist in LMICs. Objectives We aimed to assess the extent of diagnostic evaluation (for risk-factor and underlying etiological identification) and treatment approaches among recurrent stroke patients in a Ghanaian tertiary hospital. Methods This was a cross-sectional study among recurrent stroke cases admitted to Komfo Anokye Teaching Hospital between 2023 and 2024. The data was analyzed using SPSS Version 28. Results Recurrent strokes accounted for 17.8% of all stroke admissions over 2 years, with ischemic stroke comprising 76.2% of these recurrent events. Hypertension was the most dominant modifiable risk factor among both ischemic and hemorrhagic subtypes, 96.1% and 92.1% respectively, (p = 0.297). Most ischemic strokes had no diagnostic evaluation to determine etiology beyond classification as lacunar/ non-lacunar. Only 7.9% of hemorrhagic strokes underwent Computed tomography angiography (CTA)/ Magnetic resonance angiography (MRA) to evaluate for structural causes. The majority of ischemic stroke patients were prescribed a statin and an antiplatelet. However, anticoagulant therapy was used only in a minority of patients (3.91%). Carotid endarterectomy or carotid stenting was not performed for any of the ischemic stroke patients. Conclusion Our findings highlight significant gaps in recurrent stroke evaluation and management in the Ghanaian setting. Standardized algorithms for secondary stroke prevention and treatment are urgently needed to prevent recurrence.