PROGRÈS EN NEUROVASCULAIRE À L’AUBE DU 21ème SIÈCLE

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Vol. 87 No 1 (2009): Revue janv. 2009

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Ibtissem Ben Hamouda
Service de Neurologie EPS Charles Nicolle Tunis
Amel Mrabet
Service de Neurologie EPS Charles Nicolle Tunis

Résumé

But : Mise au point sur les progrès en pathologie vasculaire cérébrale.
Méthodologie : Recherche sur PubMed sur les progrès des vingt dernières années en Neurovasculaire.
Résultats : L’incidence et la prévalence des accidents vasculaires cérébraux (AVC) accusent une augmentation depuis quelques années. L’HTA est bien le facteur de risque principal, l’implication du tabagisme même passif et de l’hormonothérapie substitutive est prouvée. Des mécanismes vasculaires et cellulaires sont impliqués dans l’ischémie cérébrale. Le concept d’accident ischémique transitoire (AIT) repose désormais sur un critère lésionnel, véhiculant la notion d’urgence. L’élévation physiologique de la TA à la phase précoce de l’AVC doit être respectée chez la plupart des patients. Les progrès des explorations radiologiques ont révolutionné la prise en charge. Des marqueurs biologiques de l’AVC au stade précoce sont en cours de développement. Des nouvelles causes d’AVC sont rapportées. Les Unités Neurovasculaires ont réduit la morbi-mortalité de 50%. Le traitement a bénéficié des données d’essais cliniques solides et est de ce fait plus efficace. La rééducation physique a profité des nouvelles technologies d’évaluation du mouvement et de l’équilibre et du concept de neuroplasticité, pour mieux s’adapter aux besoins des patients.
Conclusion : La recherche en Neuro-vasculaire a connu un formidable regain d’intérêt au cours des deux dernières décennies. Les AVC constituent aujourd’hui un enjeu majeur pour la santé publique. Il est important d’organiser la filière de prise en charge des AVC afin de raccourcir les délais d’hospitalisation, de ne pas nuire et de réaliser une expertise clinique et paraclinique urgente, garante d’un choix thérapeutique optimal.

Mots-clés :

Accident vasculaire cérébral, accident ischémique transitoire, hémorragie cérébrale, infarctus cérébral, physiopathologie, imagerie, marqueurs biologiques, Unités Neurovasculaires, prévention, rééducation

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