Stroke is sudden, unpredictable and strikes a Frenchman every 4 minutes. Pierre Palmade suffered from it on February 25, 2023. What are the causes of stroke? Drugs ? The stress ?

[Updated February 26, 2023 at 9:12 a.m.] Hospitalized in addictology after his road accident on February 10, Pierre Palmade who is addicted to drugs in particular the cocaine suffered a stroke on February 25 and was transferred to the Kremlin-Bicêtre hospital in Val-de-Marne. Her pronostic vital would not be engaged. 'The occurrence of stroke is clearly associated with cocaine use, there is a direct toxic effect of the product which is a very powerful vasocontrictor and leads in particular to an occlusion of vessels in the direction of the brain' explained Professor Bruno Megarbane on the set of BFM-TV on February 26 following the stroke of Pierre palmade. 'The repeated consumption of cocaine remotely promotes a chronic inflammatory state which explains the occurrence of such strokes ' he added. Without forgetting 'the context that plays to explain the stroke as here (for the comedian, editor's note) an extremely important stress'. L' AVC is a race against time where every minute counts. However, inequalities exist in the management of this medical emergency.

What is a stroke?

A stroke is caused by blockage of a blood vessel in the brain due to a blood caillot (80% of cases) or by the rupture of a blood vessel inside the brain resulting in hemorrhage (20% of cases). The consequences can be dramatic with a lack of oxygen and glucose supply to brain cells , which can lead to their destruction, a source of neurological sequelae.

What causes a stroke?

Today it is estimated that the risk of stroke can be reduced by 90% through the control of these risk factors :

• high blood pressure ,
• diabetes,
• dyslipidemia,
• obesity,
• tobacco use
• alcohol,
• diet and sedentary lifestyle.
• cardiac arrhythmia due to atrial fibrillation

' Of all the risk factors for stroke, it is clearly hypertension that dominates the others ', explains Professor Mathieu Zuber, neurologist. It is therefore essential to monitor your blood pressure regularly with your doctor or pharmacist , to be careful not to add too much salt to your diet because salt increases blood pressure and to limit alcohol which also raises blood pressure. THE smokers have twice the risk of stroke than non-smokers, with smoking being associated with more than 1 in 4 strokes. A smoker, regardless of the number of cigarettes smoked, should make every effort to quit. In women in particular, it is necessary avoid the explosive triad' pill, migraine, tobacco ', recalls Professor Zuber. There fibrillation atriale , AF, is the most common heart rhythm disorder, and is linked to a 5 times greater risk of having a stroke.

Can drug use lead to strokes?

'Yes, the occurrence of a stroke is clearly associated with the consumption of cocaine, there is a direct toxic effect of the product which is a very powerful vasocontrictor and leads in particular to an occlusion of the vessels in the direction of the brain' explained Professor Bruno Megarbane on the set of BFM-TV on February 26 following the stroke of Pierre palmade. 'Repeated consumption of cocaine remotely promotes a chronic inflammatory state which explains the occurrence of such strokes' he added. Among the drugs most frequently implicated in strokes: psychostimulants such as cocaine and amphetamines. According to a work presented to l'International Stroke Conference (San Diego, California) in 2016, the cocaine use increases risk of stroke sevenfold ischemic within 24 hours of dosing. The strokes associated with the consumption of these drugs are most often ischemic and hemorrhagic strokes (80%), explained the Dr Anne-Evelyne Vallet in 2014.

What is an ischemic stroke?

Ischemic vascular accident, or cerebral infarction, represents more than 80 % of strokes . An ischemic stroke is caused by interruption of cerebral blood flow in the brain by a clot. Either the clot forms locally in the brain, or it comes from a more distant artery. In this second case, the clot detaches from a atherosclerotic plaque , i.e. a layer of fat that accumulates on the wall of an artery. The clot can come from an artery in the neck or form in a recess of a cavity of the heart in the case of a cardiac pathology.

What is a hemorrhagic stroke?

Hemorrhagic stroke, with more severe consequences, concerns 20% of strokes . A hemorrhagic stroke is caused by a bleeding inside the brain, flooding the brain. 'It may be related to a aneurysm rupture , which corresponds to a dilation of an artery “, explains Dr. Bertrand Lapergue, head of the neurology department at Foch Hospital (Suresnes). Ruptured aneurysms are responsible for 50% of strokes resulting in death in young people (under 45). malformation of the blood vessels in the brain most often present from birth, increases the risk of hemorrhagic stroke.High blood pressure or trauma can cause bleeding in the brain.

What is a TIA?

A few days, hours, or even minutes before a stroke, symptoms may appear transiently. These are called transient ischemic attacks or TIAs.

At what age does a stroke occur?

The average age of onset of a stroke is 74 years old (regardless of sex) but close to 25% of strokes occur before age 65 and the rate of 'young' patients hospitalized for a stroke is growing every year with large increases between ages 35 and 64 . In children under 18, stroke remains rare, less than 1%.

What are the symptoms of stroke?

Stroke strikes without warning a Frenchman every 4 minutes and risks recur in 30-40% of patients within 5 years following the first stroke. So, to minimize the risk of sequelae, or even death, it is essential to know the signs of a stroke and call 15 without waiting:

• Paralysis, weakness or numbness of part or half of the body
• mouth deformity,
• Difficulty speaking
• Loss of vision in one eye
• Problems with balance, coordination or walking
• A very strong unusual headache

These are the most common symptoms, but there are others. Unlike the myocardial infarction which is characterized by very specific pain in the chest, the stroke can indeed manifest itself differently, depending on the region of the brain that is suffering.

What are the consequences of a stroke?

The stroke creates a dam in an artery. The blood no longer passes and the artery can no longer properly irrigate the brain in order to provide it with the elements necessary for its functioning, such as oxygen or sugar. Result, the area mortifies, that is to say that the cells of the area concerned gradually die. The sequelae vary depending on the affected area. In France, about 2 out of 3 patients have sequelae after a stroke . The severity of the disorders varies from case to case. The most common sequelae are balance disorders and memory. Accepting your diminished body, facing the difficulties of everyday life, feeling intrusive for loved ones... Beyond the physical disability, you also have to deal with mental suffering. Therefore, the depressions are not uncommon . The danger is of course that they are obstacles to recovery. A psychological support , as soon as possible, is very useful to overcome the test. It allows to evacuate anxieties and negative feelings. Even in the case of speech disorders, psychologists can intervene via other means of communication.

Rehabilitation from hospitalization

To recover maximum autonomy, rehabilitation must be carried out by a specialized rehabilitation team. It can be started as soon as possible in hospital and continues at home or in a specialized center. The goals of rehabilitation are to avoid complications and recover essential functions as much as possible, such as walking, use of the upper limbs and language. Several sessions per week or even daily are necessary. The rehabilitation phase also allows you to relearn everyday gestures: washing, preparing meals, driving, etc. The specialists involved in the rehabilitation phase are, depending on the patient's state of health, a physiotherapist, occupational therapist, and speech therapist.

• L' Occupational therapist has a predominant role in helping the patient regain autonomy. Also available for relatives, it intervenes initially before returning home to prepare for discharge from hospital and anticipate what will happen next and, secondly, when returning home. Concretely, he conducts simulations to provide practical and specific answers. For everyday activities (dressing, preparing meals, administrative procedures), it offers ways of doing things, technical aids and home adaptations (wheelchair, support bars on the walls, bathtub seats) and care at home (for cleaning, meals). To regain a social life, the occupational therapist provides solutions to better accept the gaze of others, overcome communication difficulties, to move and orient oneself outside, etc.

• The physiotherapist . Even if a hemiplegic person does not regain their pre-stroke abilities, they can certainly make great strides in making the best use of their body. physiotherapy helps regain motor skills through various exercises (strengthening muscles, improving blood circulation, physical exercise, etc.) or stabilizing positions (sitting, standing). And also to recover the use of the affected limb: use the affected hand for small gestures, develop touch, etc.

'Every minute saved is 2 million neurons saved'

• L' Speech Therapist . When the left part of the brain is affected by the stroke, the sequelae generally relate to language disorders (aphasia). Concretely, the patient experiences difficulties in constructing sentences, exposing his thoughts, pronouncing words and also understanding. The work of the speech therapist consists in re-educating the written language and the oral language in parallel. . For the entourage there is no point in speaking loudly, on the other hand it is useful to speak slowly and make short sentences. Moreover, it is recommended not to pretend to understand when a message is incoherent, it is better that the person becomes aware of it. Finally, it is essential to avoid conversations with too many people and noisy atmospheres. When it is the right side that is involved, the patient loses consciousness of his left side. In fact, his brain no longer makes the connections. Thus, he often bumps into himself, he searches for objects placed on his left, his visual field obscures the left side, etc. The speech therapist will help him, little by little and over a long period, to reduce his reading difficulties, to write, to better orient himself, for example.

What to do in case of stroke?

The occurrence of a stroke requires a urgent care in the first hours occurring after the appearance of the first manifestations. The first reflex to have is to call the Samu at 15. The Samu works in a network with the neuro-vascular units (UNV), that is to say services specialized in the care of stroke patients.

• You don't have to move yourself,
• nor call his GP: it's a waste of time.
• While waiting for help, the person must remain lying down, with their head raised, in peace.
• You must also be careful not to give him food or drink because of the risk of going the wrong way.

If treatment occurs too late, physical recovery is slower and the risk of irreversible disability is greater. A rapid transfer of the patient, in the shortest possible time, to a hospital facility with an UNV allows confirmation of the cerebrovascular accident thanks to magnetic resonance imaging (MRI) and/or a scanner and to start treatment as early as possible. THE passage in a UNV is fundamental whatever the age, sex, cause and severity of the stroke, and the treatment envisaged . The UNV operates 24 hours a day. with a neurologist on call at all times. The patient accesses it directly. The UNV relies on a general neurology service. A team of specialized neurologists decides on the examinations to be carried out such as MRI or CT scan and the urgent treatments to be implemented such as thrombolysis to dissolve the clot which obstructs the artery in the event of obstruction of the artery by a clot or other treatments depending on the cause found. The passage in a UNV makes it possible to very quickly confirm the diagnosis, to seek the mechanism and the cause of the AVC and to quickly differentiate the hemorrhagic cause from that of the infarction in order to implement the appropriate treatments, to avoid the appearance of complications and to place the patient in the best conditions, to allow him to recover thanks to specific rehabilitation care.

How to diagnose a stroke?

In the presence of a suspected stroke, medical care with a brain imaging exam, CT scan or MRI , must be implemented within the first few hours. ' No symptom can differentiate the hemorrhagic form from the ischemic form, hence the importance of urgently carrying out this imaging. ', warns the specialist. The faster the treatment, the better the prognosis. More than a third of the sequelae linked to vascular accidents could be avoided.

High blood pressure: No. 1 risk factor for stroke

What are the treatments for a stroke?

A stroke requires emergency care . 20% of people with a stroke die within a few weeks of the accident and more than 30% have permanent sequelae (hemiplegia, speech disorders, disability, etc.). In the treatment of stroke, blood flow must be restored as quickly as possible to limit the effects on the brain . 'Each minute saved means 2 million neurons saved and weeks less rehabilitation for the patient who will be able to find his loved ones and his previous life more quickly' explains Professor Igor Sibon, President of the SFNV and Head of the Neurology Department - Bordeaux University Hospital. 'Thanks to early management allowing the administration of reperfusion treatment (thrombolysis or thrombectomy), today 1 out of 2 patients is completely cured.' A thrombolytic drug is given by infusion to dissolve the clot(s) blocking the cerebral artery. This treatment restores blood circulation and oxygen supply to the brain. After a stroke, antiplatelet or anticoagulant drugs are prescribed to prevent the formation of new clots and the occurrence of complications. Other medications may be prescribed after the cause of the stroke is identified: treatment of diabetes, hypertension, or excess cholesterol.

What is thrombectomy?

A new method named thrombectomie may be considered if a large artery is blocked. It consists in extracting the clot by means of a miniature net (stent) without opening the brain by passing the material through the arteries from the groin. Thrombectomy can be performed up to 24 hours after first symptoms appear , based on brain imaging data and may be used as an alternative if there is a contraindication to thrombolysis.

Thanks to Dr Bertrand Lapergue, head of the neurology department at Hôpital Foch (Suresnes). Source: AVC: every minute counts Treatments that save if you act quickly at the first symptoms! SFNV press release October 29, 2022

Source journaldesfemmes.fr