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C. Hépatite, Dépistage et traitement ? Jeudi 16 et vendredi 17 janvier 1997 -Cité des Sciences et de l'Industrie ? La Villette ? Paris (ANAES, Association Française pour l'Étude du Foie, Société Nationale Française de Gastro-Entérologie)

U. Traitement-fibrinolytique-est-envisagé, Dans ce cas, la pression artérielle doit être abaissée en dessous de 185/110 mmHg avant de débuter le traitement fibrinolytique

. -hémorragie-cérébrale, Bien que certains proposent l'abaissement à 185/110 mmHg du seuil tensionnel d'intervention thérapeutique, il n'existe pas de preuve scientifique à l'appui de cette différence de seuil comparativement à l, AVC ischémique, issue.21

L. Voies-intramusculaire-et-sublinguale-sont-À-Éviter, L'utilisation préférentielle de l'urapidil ou du labétalol ou de la nicardipine est recommandée, en évitant les doses de charge

. La-sécurité-d, utilisation de l'héparine étant mal connue chez les patients ayant un AVC hémorragique, l'utilisation d'une contention élastique immédiate des membres inférieurs, éventuellement suivie d'une héparinothérapie à doses préventives après 24-48 heures, est recommandée

. Bien-qu-'il-n, existe pas de preuve scientifique de leur efficacité, les agents hyperosmolaires (ex : mannitol, glycérol) peuvent être utilisés pendant moins de 5 jours chez les patients dont l'état clinique se détériore du fait d'un oedème cérébral

. Le, En cas de crise à la phase aiguë, un traitement antiépileptique est recommandé pour prévenir les récidives de crises (58) Les différents médicaments n'ont pas été évalués spécifiquement dans le contexte de l'AVC, y compris en cas d'état de mal (59). La durée optimale du traitement n'a pas été évaluée (60)

. La-dose-de-rt-pa-préconisée-est-de, 9 mg/kg , dose maximale 90 mg , 10 % en bolus et 90 % en perfusion d'une heure (grade A

L. Essais-cliniques-ayant-prouvé-l-'efficacité-du-rt-pa, IV ont tous été réalisés dans des centres spécialisés dans la prise en charge des AVC aigus (72) Les données disponibles (séries de cas) dans les centres non spécialisés ont montré une surmortalité par hémorragie cérébrale par rapport aux résultats observés dans les centres spécialisés, notamment du fait du non-respect des indications (73) Il est donc recommandé de ne pas utiliser le rt-PA IV en dehors d'une structure

@. Hématome-du-cervelet-l-', hydrocéphalie par obstruction du 4e ventricule est un argument d'intervention (dérivation ventriculaire externe ou ventriculo-cisternostomie endoscopique) chez les patients dont l'état clinique s'aggrave, vigilants ou avec troubles modérés de la vigilance et en l

. La-décision-d, instituer ou non une ventilation mécanique dans les suites d'un AVC aigu doit dans la mesure du possible être concertée entre réanimateurs, urgentistes, neurologues et famille du patient (94). L'absence de réflexes photomoteur et cornéen est un indicateur de forte probabilité de décès à prendre en compte dans la décision de ventilation mécanique