Hemiplegia and taking anabolic

Dr Chahinez LOUAZANIa, Dr Lylia Louiza MAOUCHEa, Dr Selim ARBAOUIa, Dr Hania MECHERIa, Dr Faouzi HASSANIa, Dr Zouhir BOUKARAa, Prof A.C. NOUARa

a CHU de Blida, Service de Médecine Physique et de Réadaptation

Introduction. Side effects of anabolic steroids are multiple and can occur early: sudden death or at a later stage, coronary heart disease occurring even after stopping taking them. We report the case of a young sportsman practicing bodybuilding as a recreation, 35 years old, without particular pathological history and having absorbed anabolic steroids for doping reasons: oxymetholone and methandrostenolone 1 tablet/D for 40 days before his stroke.

Observation. The clinical symptoms began to the awakening with the onset of functional impairment of the left side having recovered in 30 minutes followed by a left total hemiplegia with facial central ipsilateral paralysis and swallowing disorders. CT at the same evening objectified a hypodensity in the territory of the right sylvian artery which became hemorrhagic within 48 h (control CT). There was no cardiac or vascular etiology (ECG monitoring, echocardiography, doppler of supra-aortic trunks) nor thyroid disorder, inflammatory, immunologic or hemostasis disease. He was admitted in PMR at D30 after stroke: patient on a wheelchair without disorders of swallowing and with a left hemiparesis (patient right-handed), FIM at 67. At D60 the patient can walk with a tripod, is autonomous (dressing, toilet), FIM at 98. Socio-professional reintegration is ongoing (cook).

Discussion. Steroidal anabolic are known to be at the origin of cardiovascular complications by several mechanisms:

- High blood pressure by water retention.

- Cardiac rhythm disorders: reduced duration of the QTc without changing the heart rate. A QTc < 0.38 has a sensitivity of 83% and specificity of 88% to predict the use of anabolic agents. This effect is clearer in men; it is correlated with the duration of taking the product. Rhythmic disorders occur during activity or recovering; their severity goes from blackout to sudden death.

-Thromboembolic: anabolic steroids increase the platelet aggregation, antithrombin III and S-protein, and decrease fibrinolytic activity, inhibit the plasminogen activator.

-Myocardial injury: fragmentation of myofibrils, mitochondrial swelling and focused lesions of necrosis and fibrosis.

A better knowledge of the risks would certainly reduce the self-medication of these products.

J.Gauthier. AMC practice (Elsevier Masson SAS) n ° 228 may 2014.

Keywords : Hemiplegia, anabolic