Stroke: The Risks of Worsening of Brain Hemorrhages Better Assessed
Hypertention,  Stroke

Stroke: The Risks of Worsening of Brain Hemorrhages Better Assessed

Monitoring blood pressure remains the best way to prevent stroke.

There are two main types of stroke (stroke), ischemic, when an artery becomes blocked, the bleeding when bleeding. In France, more than 143,000 patients were hospitalized for a stroke in 2014 *, including 15 to 20% by hemorrhage, according to the weekly epidemiological bulletin (February 2017).

Of the two types of accidents, cerebral hemorrhage is the most feared, although it is four times less frequent. First because it is very often fatal, then because, unlike ischemia, there is no effective treatment to date, finally for the significant after-effects it often leaves in survivors. “Over the past twenty years, there has been significant progress in the treatment of ischemic attack, but in hemorrhage, mortality is 50% at one month and half of the survivors remain disabled.” In addition, the initial bleeding, which is responsible for the symptoms, can worsen and the hematoma continues to grow in the brain, especially in the first 48 hours.

“It is very difficult to make a prognosis prognosis in the event of a stroke, but it is even more true in the event of a hemorrhage”

Pr Yannick Béjot, neurologist at the Dijon CHU

“It is very difficult to make a prognosis prognosis in case of stroke, but it is even more true in case of hemorrhage”, explains to Le Figaro Professor Yannick Béjot, neurologist at the Dijon CHU and scientific director of the registry the oldest stroke in the world (funded since 1985 by Inserm and Public Health France). “Obviously, a large hematoma is more likely to get worse, but a small hematoma in a strategic location of the brain can also do considerable damage, even death,” he adds.

The international study published in the October issue of The Lancet Neurology did not focus on the hemorrhagic area but on the risk of worsening. The authors used data from 36 cohorts to gather the characteristics of 5,435 patients who suffered from hemorrhagic stroke. “This is considerable work, comments Professor Béjot, who shows that it is possible with a few simple data to identify the patients who are most at risk of seeing their hemorrhage worsen.”

If today there is no effective treatment, apart from maintaining the arterial pressure at a reasonable level (neither too high nor too low), the research in progress aims ultimately to be able to offer treatment to patients the more at risk. For example, people who have a brain hemorrhage while on anticoagulants or antiplatelet drugs (aspirin). It is the main risk factor for worsening of the hemorrhage found in the Lancet Neurology study .

“Be careful, this does not mean that these treatments should no longer be taken when they have been prescribed, because it is generally to avoid another even more frequent danger, ischemia, especially of the heart (infarction) or of the brain (stroke) ”, warns Professor Charlotte Cordonnier (Inserm), head of the neurology service at the Lille University Hospital. “But that underlines the importance of a good assessment of the benefit-risk balance when prescribing,” she said.

“Whether it is an ischemic or haemorrhagic stroke, it has been shown that management in a specific stroke stream reduces mortality”

Pr Charlotte Cordonnier (Inserm)

In secondary prevention (after a cardiovascular accident), anticoagulation is the rule. For primary prevention, a study presented last month at the congress of the European Cardiology Society (ESC) showed that for people at low cardiovascular risk, the daily intake of 100 mg of aspirin was useless. However, the vast majority of people who have a stroke are not on aspirin. In the study, 5076 of the 5435 patients analyzed did not take it. And 20% of them still saw their hematoma increase in size.

Can you reduce your risk of having a brain hemorrhage? For Professor Béjot, “the most important message is to monitor your blood pressure, because it is the main risk factor. With blood pressure monitoring devices, it’s easy to check your blood pressure yourself and consult your doctor in case of an anomaly. ”

The other important advice is to call 15 if symptoms of stroke appear: deformation of the face, difficulty speaking, vision impairment, paralysis or weakness of an arm or leg. “Whether it is an ischemic or haemorrhagic stroke, it has been shown that treatment in a specific stroke sector reduces mortality,” explains Professor Cordonnier.

It would still be necessary for the neurovascular units already present on the territory to develop their reception capacities. “The needs increase every year because the population is aging, and within fifteen years, we will have 30% more stroke,” notes Professor Béjot.

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