Six things to know about stroke

On June 29, Le Figaro Santé met Professor Yves Samson, head of the cerebrovascular emergency department at the Pitié-Salpêtrière hospital in Paris. From the Brain and Spinal Cord Institute (CMI), he has been answering Internet users' questions about stroke.

1. What is Stroke?

Stroke is a serious accident related to dysfunction of the vascularization of the brain – that is, the brain is brutally deprived of blood, and therefore oxygen. These very frequent accidents can lead to deficits of movement, language disorders or loss of sensitivity. "There are about 150,000 cerebrovascular accidents a year in France," says Prof. Yves Samson.

There are two types, the most common of which is ischemic stroke: "it is a vessel that clogs, which results in a brain infarction," says the doctor, "they account for 80% of strokes ". The remaining 20% ​​is caused by a so-called haemorrhagic accident: unlike ischemia, the vessel bursts and causes haemorrhage in the brain

2. Is this a significant cause of death?

Mortality from stroke is declining. Between 2008 and 2013, it decreased by 13%, according to Public Health France. However, this remains the leading cause of death among women in France. Of the 31,000 people who died of stroke in 2015, more than half were women, according to the Center for Epidemiology of Medical Causes of Death (CépiDc).

Before age 70, men are most often affected. In contrast, beyond this age, "stroke is more common among women," says Yves Samson. After 85 years, 70% of the victims are women.

In recent years, the average age of onset of stroke has declined to 71 years for men and 75 years for women. "That said, about 10% of strokes occur in children under 50, or 15,000 people a year in France," says Professor Samson.

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3. What are the symptoms of a stroke?

The acronym FAST – "fast", in English – is an effective mnemonic. Each letter corresponds to a symptom. The "F" comes from face or face in English, for asymmetry of the face: a falling mouth, or an eye that closes. The "A" comes from arm (arm), for the sudden weakness of an arm, and the "S", from speech (speech, language): the voice that becomes abnormal, language disorders that appear. Finally, T for time : it is essential to quickly take care of the patient who presents these symptoms

"Signs are often badociated but not always," says Pr Yves Samson. If one or more of these symptoms occur suddenly, "call 15 or firefighters immediately because emergency treatment greatly improves the prognosis," he warns. It's better to call the hospital once more than to arrive too late. "

4. What are the first aid actions to perform?

The first thing to do is to find the time of onset of symptoms. "It's not necessarily the same as the time when you discover the person," says the doctor. Then to note it, because in the stress, it is easy to forget a few tens of minutes. But "the minutes that pbad are essential," he warns. Finally, call the UAS immediately, and if it takes time to answer, the firemen.

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5. What solutions exist to remedy this?

The first step is a brain imaging test: either a scanner or an MRI. The objective is to know if it is a haemorrhagic (hematoma) or ischemic (a clot) accident. This helps to define what types of medications to prescribe to the patient. "You do not give drugs that destroy clots to people who have bruises," says Dr. Samson

For ischemic-type stroke, there are two options. If an artery is blocked and the patient is taken care of sufficiently early, a catheter is inserted and the clot is removed: this is thrombectomy, which greatly improves the prognosis. "Thrombectomy has been around for 20 years," says the doctor, "but until 2013, there were very few trials, and those that existed considered treatment too dangerous."

Along with it, another technique is often used in a complementary way: intravenous thrombolysis. It involves bringing a catheter into the clogged intracerebral vessel to catch the clot and remove it. However, this treatment is only effective if the patient is treated very quickly. If more than four and a half hours elapse after the stroke, they become too dangerous.

"READ ALSO – Transient ischemic attacks, short but formidable cerebral seizures

6. Statins: What Does Science Say?

Statins are drugs that have been prescribed for years to lower the level of "bad" cholesterol. The higher this rate, the greater the risk of having a cardiovascular event. But in 2013, statins were at the heart of a controversy, when scientific studies pointed to the fact that some patients consumed it unnecessarily. "Contrary to what has been said, this is one of the great discoveries of current cerebrovascular medicine," Yves Samson reacts.

Among the accepted ideas: statins cause cramps and rupture of tendons. But "in very many trials, there are exactly as many cramps in the group of people who take placebo, that is to say, perlimpinpin powder, as in the group of those who take statins," stresses the doctor.

One thing is certain: statins have an indisputable efficacy in secondary prevention, that is to say for patients who have already had a cardiovascular accident (myocardial infarction, stroke). However, for people who have never had such health problems, the decision to prescribe statins should be made on a case-by-case basis. This is justified for people at high risk, as recalled by the High Authority of Health in its latest recommendations.

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