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Abstract
RÉSUMÉ
Introduction. L'accident vasculaire cérébral (AVC) est une pathologie grave et parfois invalidante, dont l'incidence augmente avec l'âge à partir de 55 ans. La particularité chez le sujet âgé est que l'incidence des facteurs de risque cardiovasculaire (hypertension, fibrillation auriculaire, diabète, athérosclérose) augmente proportionnellement avec l'âge. Notre objectif est de décrire les aspects épidémiologiques cliniques et paracliniques de l'AVC chez le sujet âgé dans le service de médecine interne du CHU du Point G. Patients et méthodes. Nous avons réalisé une étude descriptive avec enquête rétrospective pour la période allant du 1er Janvier 2010 au 31 Décembre 2018 et prospective sur la période du 1er Janvier 2019 au 31 Décembre 2019. Les données ont été relevées sur des fiches d’enquêtes anonymes. Nos variables d’étude étaient les données sociodémographiques et cliniques. Le diagnostic était basé sur la combinaison de critères cliniques et scanographiques. Résultats. Nous avons colligé 26 cas d’AVC du sujet âgé sur 835 hospitalisations donnant une fréquence hospitalière de 3,1%. L’âge moyen des sujets était de 76,4 ± 6,9 ans. L’hypertension artérielle (HTA) et un antécédent d’AVC étaient retrouvés respectivement chez 65,3% et 15,3% de cas. Les AVC ischémiques étaient les plus fréquents (88,5%) versus 11,5% pour les AVC hémorragiques. Le traitement antiagrégant plaquettaire a été instauré chez 69,2% et anticoagulant chez 15,4%. La mortalité hospitalière était de 12,5%. Conclusion. La prévalence des AVC du sujet âgé est de 3,1% en médecine interne. L’HTA est le principal facteur de risque. L’AVC ischémique est quater fois pks fréquent que l’hémorragique. La mortalité est élevée. Elle pourrait être réduite avec la mise en place d’unités de soins neuro vasculaires.
ABSTRACT
Introduction. Stroke is a serious and sometimes disabling pathology. Its incidence increases with age from 55 years. This may be linked to the fact that that the incidence of cardiovascular risk factors (hypertension, atrial fibrillation, diabetes, and atherosclerosis) also increases proportionally with age. The objective was our study is to report the clinical and epidemiological features of stroke in the elderly in the internal medicine department of the University Teaching Hospital Point G. Patients and Methods. We carried out a descriptive retrospective survey for the period from January 1, 2010 to December 31, 2018 and prospective for the period from January 1, 2019 to December 31, 2019. The data were collected from survey anonymous sheets. Our data of interest were the clinical and epidemiological features of stroke in patients aged 65 years or more. Stroke was diagnosed on the basis of clinical and CT findings. Results. We found 26 elderly patients having suffered of stroke out of 835 hospitalizations, giving a hospital frequency of 3.1%. Their average age was 76.4 ± 6.9 years. High blood pressure and a history of stroke were found in 65.3% and 15.3% of cases, respectively. Ischemic stroke was the most common variety (88.5%) versus 11.5% for hemorrhagic stroke. Antiplatelet therapy was initiated in 69.2% of patients and anticoagulation in 15.4% of cases. The mortality rate was 12.5%. Conclusion. The hospital frequency of stroke is 3.1%. High blood pressure is the leading risk factor. Ischemic strike is far more common than hemorrhagic stroke. The mortality is high. This may be reduced with the implementation of units of neurovascular care.
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References
- Rouaud O, Contegal F, Benatru I et al. Particularités de l’accident vasculaire cérébral du sujet âgé et impact sur la prise en charge Volume 3, numéro 3, Septembre 2005: 147-55.
- Pellerin C, Mauget Y, Bouju A, et al. Accident vasculaire cérébral. Médecine d'urgence 2003, p. 107-17.
- BéjotY , Bailly H , Graber M ; Impact of the Ageing Population on the Burden of Stroke: The Dijon Stroke Registry.Neuroepidemiology. 2019;52(1-2):78-85.
- Sautereau A.Accident vasculaire cérébral de la personne âgée, particularités et facteurs pronostiques. These Med, Université Pierre et Marie Curie, Paris, 2009.
- Wang Z, Hu S, Sang S, Luo L, Yu C. Age-period-cohortanalysis of stroke mortality in China: data from the Global Burden of DiseaseStudy 2013. Stroke. 2017; 48:271–75.
- Touré M. Etude épidémio-clinique et évolutive des AVC hypertensifs en cardiologie A Thèse Med, Bamako, FMOS, USTTB, 2007 ; N°164.
- Dantas LF, Marchesi JF, Peres IT, Hamacher S, Bozza FA, QuintanoNeira RA (2019) Public hospitalizations for stroke in Brazilfrom2009 to 2016. PLoS ONE 14(3): e0213837.
- Shitandi OB, Alexander OJ, Kerubuo MM, Ngure KB. Pattern of stroke in a rural Kenyan hospital. Malawi Medical Journal 2019 ; 31 (1): 50-5.
- Dabilgou A, Adeline kyelem JM, Dravé A, Tanguy NIkiema MI, Napon C, Kabore J. Les accidents vasculaires cérébraux chez le sujet âgé en milieu tropical : aspects épidémiologiques, cliniques et facteurs pronostiques. NPG Neurologie-psychiatrie-gériatrie(2018) 18: 133-9.
- Lisabeth L, Bushnell C. Stroke risk in woman: the role of menopause and hormone therapy. Lancet Neurol. 2012; 11 (1): 82-91.
- Lu H,*, Guo Z, Liu J, Zhang H et al. Trends in stroke incidence among elderly low-income residents of rural China: a population-based study from 1992 to 2016. AGING 2018, Vol. 10, No. 11: 3438-49.
- Krause DN, Duckles SP, Pelligrino DA. Influence of sex steroid hormones on cerebrovascular function. J Appl Physiol (1985). 2006; 101:1252–61.
- McCullough LD, Hurn PD. Estrogen and ischemic neuroprotection: an integrated view. Trends Endocrinol Metab. 2003; 14:228–35.
- Walker R, Whiting D, Unwin N, Mugusi F, Swai M, Aris E, et al. Stroke incidence in rural and urban Tanzania: a prospective community based study. Lancet Neurol. 2010; 9(8): 786 – 92.
- Gong Y, Wei X, Liang Y, Zou G, Hu R, Deng S, et al. Urban and Rural Differences of Acute cardio-vascular Disease Events: A study from the Population Based Real- Time Surveillance system in Zhejiang, China in 2012 PLOS ONE 11(11): e0165647.
- Jackson CA, Jones M, Mishra GD. Educational and homeownership inequalities in stroke incidence: a population-based longitudinal study of mid-aged women. Eur J Public Health. 2014; 24:231–36.
- http//www.geriatrie-tn.org/Posters/Z_Hfaiedh.pdf. Consulté le 10 Novembre 2018.Hfaiedh Z. Accident vasculaire de la personne âgée dans le service de médecine régional de Kebil (Tunise).
- Maredza M, Bertram MY, Tollman SM. Disease burden of stroke in rural South Africa: an estimate of incidence, mortality and disability adjusted life years. BMC Neurol. 2015; 15: 54.
- Jowi JO, Mativo PM. Pathological sub-types, risk factors and outcome of stroke at the Nairobi hospital, Kenya. East Afr. Med J. 2008; 85: 572-581.
- Wasay M, Khatri IA, Kaul S. Stroke in South Asian countries. Nat Rev Neurol. 2014; 10(3): 135 – 43.
- Nigo M, Walker A, Lucido D, Shah A, Skliut M, Mildvan D. Stroke in human immunodeficiency virus (HIV) infected patients. Presented as part of the International AIDS conference, Washington DC. 2012:22-7.
- Benjamin LA, BryerA, Emsley HCA, Khoo S, Solomon T. HIV infection and stroke: current perpectives and future directions. Lancet Neurol. 2012. 11(10): 878 – 90.
- Dobbs MR, Berger JR. Review Stroke in HIV infection and AIDS. Expert Rev Cardiovasc Ther. 2009 Oct; 7(10): 1263- 71
- O’Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. Elsevier; 2016; 388: 761–775.
- Mapouré YN et al. Incidence des accidents vasculaires cérébraux chez les patients VIH positifs sous traitement antirétroviral au long court. Pan African Medical Journal. 2016; 24:45 doi:10.11604/pamj.2016.24.45.8013
- Zaorsky NG, Zhang Y, Tchelebi LT. Stroke among cancer patients. NATURE COMMUNICATIONS 2019;10: 5172.
- Dearborn, J. L., Urrutia, V. C. &Zeiler, S. R. Stroke and cancer a complicated relationship. J. Neurol. Transl. Neurosci.2014; 2: 1039.
- Waldo AL, Becker RC, Tapson VF, Colgan KJ, NABOR steering committee. Hospitalized patients with atrial fibrillation and a high risk of stroke not being provided with adequate anticoagulation. J Am Coll Cardiol. 2005; 46(9): 1729 – 36.
References
Rouaud O, Contegal F, Benatru I et al. Particularités de l’accident vasculaire cérébral du sujet âgé et impact sur la prise en charge Volume 3, numéro 3, Septembre 2005: 147-55.
Pellerin C, Mauget Y, Bouju A, et al. Accident vasculaire cérébral. Médecine d'urgence 2003, p. 107-17.
BéjotY , Bailly H , Graber M ; Impact of the Ageing Population on the Burden of Stroke: The Dijon Stroke Registry.Neuroepidemiology. 2019;52(1-2):78-85.
Sautereau A.Accident vasculaire cérébral de la personne âgée, particularités et facteurs pronostiques. These Med, Université Pierre et Marie Curie, Paris, 2009.
Wang Z, Hu S, Sang S, Luo L, Yu C. Age-period-cohortanalysis of stroke mortality in China: data from the Global Burden of DiseaseStudy 2013. Stroke. 2017; 48:271–75.
Touré M. Etude épidémio-clinique et évolutive des AVC hypertensifs en cardiologie A Thèse Med, Bamako, FMOS, USTTB, 2007 ; N°164.
Dantas LF, Marchesi JF, Peres IT, Hamacher S, Bozza FA, QuintanoNeira RA (2019) Public hospitalizations for stroke in Brazilfrom2009 to 2016. PLoS ONE 14(3): e0213837.
Shitandi OB, Alexander OJ, Kerubuo MM, Ngure KB. Pattern of stroke in a rural Kenyan hospital. Malawi Medical Journal 2019 ; 31 (1): 50-5.
Dabilgou A, Adeline kyelem JM, Dravé A, Tanguy NIkiema MI, Napon C, Kabore J. Les accidents vasculaires cérébraux chez le sujet âgé en milieu tropical : aspects épidémiologiques, cliniques et facteurs pronostiques. NPG Neurologie-psychiatrie-gériatrie(2018) 18: 133-9.
Lisabeth L, Bushnell C. Stroke risk in woman: the role of menopause and hormone therapy. Lancet Neurol. 2012; 11 (1): 82-91.
Lu H,*, Guo Z, Liu J, Zhang H et al. Trends in stroke incidence among elderly low-income residents of rural China: a population-based study from 1992 to 2016. AGING 2018, Vol. 10, No. 11: 3438-49.
Krause DN, Duckles SP, Pelligrino DA. Influence of sex steroid hormones on cerebrovascular function. J Appl Physiol (1985). 2006; 101:1252–61.
McCullough LD, Hurn PD. Estrogen and ischemic neuroprotection: an integrated view. Trends Endocrinol Metab. 2003; 14:228–35.
Walker R, Whiting D, Unwin N, Mugusi F, Swai M, Aris E, et al. Stroke incidence in rural and urban Tanzania: a prospective community based study. Lancet Neurol. 2010; 9(8): 786 – 92.
Gong Y, Wei X, Liang Y, Zou G, Hu R, Deng S, et al. Urban and Rural Differences of Acute cardio-vascular Disease Events: A study from the Population Based Real- Time Surveillance system in Zhejiang, China in 2012 PLOS ONE 11(11): e0165647.
Jackson CA, Jones M, Mishra GD. Educational and homeownership inequalities in stroke incidence: a population-based longitudinal study of mid-aged women. Eur J Public Health. 2014; 24:231–36.
http//www.geriatrie-tn.org/Posters/Z_Hfaiedh.pdf. Consulté le 10 Novembre 2018.Hfaiedh Z. Accident vasculaire de la personne âgée dans le service de médecine régional de Kebil (Tunise).
Maredza M, Bertram MY, Tollman SM. Disease burden of stroke in rural South Africa: an estimate of incidence, mortality and disability adjusted life years. BMC Neurol. 2015; 15: 54.
Jowi JO, Mativo PM. Pathological sub-types, risk factors and outcome of stroke at the Nairobi hospital, Kenya. East Afr. Med J. 2008; 85: 572-581.
Wasay M, Khatri IA, Kaul S. Stroke in South Asian countries. Nat Rev Neurol. 2014; 10(3): 135 – 43.
Nigo M, Walker A, Lucido D, Shah A, Skliut M, Mildvan D. Stroke in human immunodeficiency virus (HIV) infected patients. Presented as part of the International AIDS conference, Washington DC. 2012:22-7.
Benjamin LA, BryerA, Emsley HCA, Khoo S, Solomon T. HIV infection and stroke: current perpectives and future directions. Lancet Neurol. 2012. 11(10): 878 – 90.
Dobbs MR, Berger JR. Review Stroke in HIV infection and AIDS. Expert Rev Cardiovasc Ther. 2009 Oct; 7(10): 1263- 71
O’Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. Elsevier; 2016; 388: 761–775.
Mapouré YN et al. Incidence des accidents vasculaires cérébraux chez les patients VIH positifs sous traitement antirétroviral au long court. Pan African Medical Journal. 2016; 24:45 doi:10.11604/pamj.2016.24.45.8013
Zaorsky NG, Zhang Y, Tchelebi LT. Stroke among cancer patients. NATURE COMMUNICATIONS 2019;10: 5172.
Dearborn, J. L., Urrutia, V. C. &Zeiler, S. R. Stroke and cancer a complicated relationship. J. Neurol. Transl. Neurosci.2014; 2: 1039.
Waldo AL, Becker RC, Tapson VF, Colgan KJ, NABOR steering committee. Hospitalized patients with atrial fibrillation and a high risk of stroke not being provided with adequate anticoagulation. J Am Coll Cardiol. 2005; 46(9): 1729 – 36.