Marie, seated in her armchair, enjoys her meal with relish. “Whatever happens, I’m hungry,” she concedes, indifferent to the monitoring beeping above her head. Feet placed on his hospital bed, in the intensive care department of the neurovascular unit…
Marie, seated in her armchair, enjoys her meal with relish. “Whatever happens, I’m hungry,” she concedes, indifferent to the monitoring beeping above her head. With her feet placed on her hospital bed, in the intensive care department of the neurovascular unit of the Bordeaux University Hospital, she smiles at his good joke. “I’m a die-hard optimist, and when I woke up one morning with tingling around my mouth and in my hand, my first thought was something odd. As it lasted all day, I went to the emergency room at Saint-André hospital. Once I had an MRI and a CT scan, I said ”alright, you’ve seen everything, I’m going home”. But no, they sent me to this department. I was having a stroke. » At 78 years old, Marie claims the weight of a young girl, the same goes for her blood pressure and an eight-kilometre daily walk. “Well, it’s true, I smoked a pack a day for a long time. »
Streamline the route to save time
Each year, 2,000 patients are treated in this department of the University Hospital. 16 intensive care beds and 32 post-intensive beds, before, either a return home if all goes well or a stay in a rehabilitation center if luckily we find places. According to data from the Court of Auditors and Public Health France, stroke will affect one in five French people and one in four women during their lifetime. In addition to 35,000 deaths each year in the country, it is also the leading cause of acquired disability and the second leading cause of dementia. Doctors Pauline Renou and Stéphane Olindo, neurologists within the unit, which includes the transient ischemic attack (TIA) clinic, stroke emergencies with dedicated interventional imaging room and intensive care, remind us how time is limited. Every minute lost after a stroke sees the destruction of two million neurons. Marie had a narrow escape, after waiting a day before going alone to the emergency room, where she waited. “Faced with a symptom, a suspicion of stroke, you must call 15,” chant the two doctors.
“Only 50% of people who have had a stroke will be treated in a neurovascular service”
“It must be a reflex,” continues Doctor Renou. Alert the 15th, to allow the sector to be as fast as possible. A protocol has been described by the High Authority for Health, it is optimized. From this phone call, the patient is taken by the most suitable medical transport, ambulance or helicopter, to the nearest neurovascular unit. He will not wait his turn and will be immediately taken care of by an expert doctor, will undergo imaging exams as soon as possible and will benefit from appropriate therapy, early. » If it is an ischemic stroke, with thrombosis – 80% of cases – it will be thrombolysis by perfusion which can dissolve the clot. If it is a hemorrhagic stroke, it will be necessary to lower the blood pressure immediately. “Yes, but only neurologists are able to prescribe these therapies,” comments Doctor Olindo. Sometimes thrombolysis will not be enough, the patient will have to undergo a thrombectomy, an intervention which allows the clot to be found in the brain, under fluoroscopic control, via a catheter slipped through the femoral artery. » Only hospitals classified as “recourse centers”, such as the Bordeaux University Hospital, the Bayonne or Pau hospital in the region are authorized to perform this procedure.
Doctors Pauline Renou and Stéphane Olindo, neurologists in the neurovascular unit of Bordeaux University Hospital, which treats 2,000 patients each year.
Laurent Theillet / SO
A little revolution
“The University Hospital takes care of patients from Gironde, Lot-et-Garonne and Dordogne for thrombectomies, the hospitals of Bayonne and Pau take care of those living in the Pyrénées-Atlantiques and Landes,” explains Doctor Olindo. To carry out thrombolysis, small field hospitals are now equipped with a telemedicine system. The doctor on site calls the neurologist here, we exchange information, images of the patient and prescribe if necessary. » A small revolution, initiated in 2014 by Doctor François Rouanet, head of the clinical neuroscience center of the CHU which allowed the whole of New Aquitaine to be connected to this regional platform of experts.
Every minute lost after a stroke sees the destruction of two million neurons