Hemiplegia and taking anabolic

Abstract

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. 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). 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. Anabolic steroids increase the platelet aggregation, antithrombin III and S-protein, and decrease fibrinolytic activity, inhibit the plasminogen activator. 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.