“We have to go extremely quickly. » Marco Pasi is a neurology doctor at CHRU Bretonneau, in Tours. Its service sees more than 2,000 people per year, the vast majority victims of cerebrovascular accidents (CVA).
Affecting 140,000 people in France each year, strokes are the third cause of death in the country.
The leading cause of disability among the elderly, strokes also exist among younger people. One in ten people affected is under 55 years old.
“After the deadlines, we can no longer process”
The reaction time must be as short as possible. In the case of ischemic stroke – when a blood clot blocks an artery in the brain, which is the vast majority of cases – two interventions are possible. Within four and a half hours, doctors can inject medicine to dissolve the clot. This is thrombolysis. Within twenty-four hours, they can remove the clot mechanically in surgery. This is thrombectomy.
The signs of a stroke are distortion of the face or mouth, numbness of an arm or leg, difficulty speaking or understanding, loss of balance, etc. If in doubt, it is important to dial 15 or 112.
“If we are past the deadlines, we cannot process”explains Marco Pasi. The brain tissue is too damaged by the stroke to be able to intervene, at the risk of causing hemorrhage, explains the doctor. “Afterwards, we are harmful. »
“A little nugget”
Each year, doctors from the neurology department in Tours treat more than 500 ischemic strokes, more than 120 cerebral hemorrhages and more than 100 transient ischemic attacks (TIA). In the latter cases, the arteries are only temporarily blocked, causing no brain damage. The service is “a little nugget, smiles Marco Pasi, because it works very well. We don't have any problems with doctors. »
-The unit thus offers 8 intensive care beds, two intervention rooms, and 22 beds for stabilized patients. In addition, there are two intervention rooms. In 2023, an investment of 10 million euros will provide the service with a new technical platform.
“Our goal is to care for all patients who can be offered revascularization treatment, advance Marco Pasi. We manage to do it. We will always take someone when we are on deadline. We really try to do as much as possible. »
“Waste less time”
Doctors from Tours are able to guide emergency doctors from peripheral hospitals, such as Blois and Châteauroux, remotely in carrying out thrombolysis. Around fifty of these remote interventions are carried out each year. A figure which should be expected to increase, “to waste less time”underlines the doctor.
The only blind spot in the neurology department: transient ischemic attacks (TIA). Treated by emergency departments, people suffering from a TIA undergo an examination to assess whether they are at risk of developing a stroke. They are not automatically admitted to neurology.
Last November, a resident of Indre-et-Loire suffering from a TIA, which turned into a definitive stroke, waited five days before being admitted to the neurology department. He is now paralyzed in half of his body. A situation which remains exceptional, assures Marco Pasi.
“For the moment, we can’t take them, we don’t have room here”regrets the doctor. But the move to the New Trousseau Hospital, which is due to open its doors in 2029, could change the situation. “All AIT will be centralized in Trousseau. We will take care of them”advance Marco Pasi.
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