Timing of neuroimaging and its implications in the management of stroke in Port Harcourt, Nigeria: is time really brain?

Modern evidence-based stroke management is contingent on rapid neuroimaging, yet in most resource-constrained settings, several barriers frequently prevent timely brain imaging. This study examines the timing of neuroimaging and its clinical implications for patients with stroke managed at a tertiary referral centre in Port Harcourt, Nigeria. A prospective hospital-based cohort study conducted at the University of Port Harcourt Teaching Hospital between January 2023 and December 2025. Two hundred and seventy-nine patients with radiologically confirmed stroke were included. Primary outcomes were time from ictus to neuroimaging and its association with functional outcome (modified Rankin Scale [mRS] at four weeks) and in-hospital mortality. Logistic regression identified independent predictors of imaging delay. The mean patient age was 59.1 years; 57.4% were male. Ischaemic stroke accounted for 64.2% and haemorrhagic stroke for 35.8% of cases. Only 13.98% of patients arrived within six hours of experiencing symptoms, and a mere 2.15% underwent neuroimaging within the same timeframe. The predominant reason for imaging delay was financial constraint (91.76%). At four weeks, 29.4% of patients had died, 21.9% had severe disability or death (mRS 5–6), and only 47.3% achieved a favourable functional outcome (mRS 0–2). No patient in our cohort received thrombolytic therapy. Neuroimaging delay in stroke management in Port Harcourt, Nigeria is near-absolute and overwhelmingly driven by patient-borne financial barriers and sometimes equipment unavailability. The “time is brain” paradigm, which is fundamental to modern stroke care globally, is unrealistic without a comprehensive stroke program that addresses the initial needs of patients, such as neuroimaging during the acute phase. Universal health coverage and dedicated stroke pathway funding are imperative to close this outcome gap.