Un accident vasculaire cérébral ou Accident cérébrovasculaire survient lorsque le flux sanguin vers une partie du cerveau s’arrête. On l’appelle parfois un « AVC”. Si le flux sanguin s’arrête pendant plus de quelques secondes, le cerveau ne peut pas recevoir de nutriments et d’oxygène. Les cellules du cerveau peuvent mourir, causant des dommages permanents. Un accident vasculaire cérébral survient lorsqu’un vaisseau sanguin dans le cerveau se rompt provoquant un saignement à l’intérieur de la tête.

Causes de l’AVC

Il existe deux principaux types d’AVC:

  1. AVC ischémique
  2. AVC hémorragique

Un AVC ischémique survient lorsqu’un vaisseau sanguin alimentant le cerveau en sang est bloqué par un caillot sanguin. Cela peut se produire de deux manières:

  1. Un caillot peut se former dans une artère déjà très étroite. C’est ce qu’on appelle un accident vasculaire cérébral thrombotique.
  2. Un caillot peut se détacher d’un autre endroit dans les vaisseaux sanguins du cerveau ou de quelque part dans le corps et voyager jusqu’au cerveau. C’est ce qu’on appelle une embolie cérébrale ou un accident vasculaire cérébral embolique.

Les accidents vasculaires cérébraux ischémiques peuvent également être causés par une substance collante appelée plaque qui peut obstruer les artères.

Un accident vasculaire cérébral hémorragique survient lorsqu’un vaisseau sanguin dans une partie du cerveau s’affaiblit et se rompt. Cela provoque une fuite de sang dans le cerveau. Certaines personnes ont des défauts dans les vaisseaux sanguins du cerveau qui rendent cela plus probable. Ces défauts peuvent inclure :

  1. Anévrisme (une zone faible dans la paroi d’un vaisseau sanguin qui provoque la formation d’un renflement ou d’une bulle à l’extérieur du vaisseau)
  2. Malformation artérioveineuse (MAV ; une connexion anormale entre les artères et les veines)
  3. Angiopathie du cerveau amyloïde (ACA): une condition dans laquelle les protéines amyloïdes s’accumulent sur les parois des artères du cerveau)
  4. Des accidents vasculaires cérébraux hémorragiques peuvent également survenir lorsqu’une personne prend des anticoagulants, tels que la warfarine (Coumadin). Une pression artérielle très élevée peut provoquer l’éclatement des vaisseaux sanguins, entraînant un accident vasculaire cérébral hémorragique.
  5. Un AVC ischémique peut saigner et se transformer en AVC hémorragique.
  6. L’hypertension artérielle est le principal facteur de risque d’AVC.

D’autres facteurs de risque importants de l’AVC incluent:

  1. – Fréquence cardiaque irrégulière, appelée aussi Taux Fibrillation auriculaire;
  2. – Diabète;
  3. – Être un homme;
  4. – Antécédents familiaux de la maladie;
  5. – Taux Élevé de cholestérol;
  6. – Age croissant, surtout après 55 ans;
  7. – Origine ethnique (les Noirs sont plus susceptibles de mourir d’un AVC);
  8. – Obésité;
  9. – Antécédents d’AVC ou accidents ischémiques transitoires (qui se produisent lorsque le sang afflue vers une partie du cerveau qui s’arrête pendant une courte période).

Le risque d’accident vasculaire cérébral est également plus élevé chez :

  1. Les personnes qui ont une maladie cardiaque ou une mauvaise circulation dans les jambes causée par le rétrécissement des artères.
  2. Les personnes qui ont des habitudes de vie malsaines telles que le tabagisme, la consommation excessive d’alcool, la consommation de drAccident cérébrovasculaireogues, un régime riche en graisses et le manque d’exercice.
  3. Les femmes prenant des pilules contraceptives (en particulier celles qui fument et ont plus de 35 ans)
  4. Les femmes enceintes courent un risque accru pendant la grossesse
  5. Les femmes prenant un traitement hormonal substitutif

* Foramen ovale persistant (FOP): un trou entre les oreillettes gauche et droite (chambre supérieure) du cœur.

Prévenir, la meilleure stratégie pour lutter contre les AVC

La prévention du premier AVC (dite « prévention primaire ») est particulièrement importante puisque ceux-ci représentent 75% des cas. Cette prévention repose principalement sur le dépistage et le traitement des facteurs de risque vasculaires.

Reconnaître les symptômes

  1. Compte tenu de l’urgence médicale que constitue un AVC, il est très important d’en connaître les symptômes. Ceux-ci sont extrêmement divers car ils dépendent de la localisation exacte de la lésion, chaque partie du cerveau étant spécialisée dans des tâches particulières ou de la coordination des membres.
  2. Des troubles de la vigilance pouvant aller jusqu’au coma.
  3. Un mal de tête brutal, intense et inhabituel.

(mouvement, sensibilité, vision, langage…). Cependant, certains signes très fréquents doivent donner l’alerte:

  1. Une faiblesse musculaire, une paralysie d’un ou plusieurs membres ou du visage, le plus souvent d’un seul côté du corps (hémiplégie);
  2. Une perte de sensibilité ou un engourdissement d’un ou plusieurs membres ou du visage;
  3. Une perte de la vision d’un œil (cécité unilatérale) ou de la moitié du champ visuel pour chaque œil (hémianopsie), ou encore une vue double (diplopie);
  4. Des difficultés à parler, soit en raison d’une difficulté à articuler (dysarthrie) et/ou à trouver ses mots, soit en raison de l’utilisation de mots inintelligibles et/ou de difficultés à comprendre ce que l’on entend (aphasie);
  5. Des troubles de l’équilibre ou de la coordination des membres;
  6. Des troubles de la vigilance pouvant aller jusqu’au coma;
  7. Un mal de tête brutal, intense et inhabituel.

Dr. Marie Phara AMBROISE

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