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Behandlung schwerster Schlaganfälle auf der Intensivstation

Maligner Mediainfarkt – intrazerebrale Blutung – Subarachnoidalblutung

Current intensive care strategies for the treatment of severe stroke

Malignant infarction of the middle cerebral artery – intracerebral hemorrhage – subarachnoid hemorrhage

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Zusammenfassung

Die Prognose von Patienten mit schwersten Schlaganfällen hat sich durch neue Therapieoptionen und Fortschritte in der intensivmedizinischen Versorgung in den letzten Jahren deutlich verbessert. Im vorliegenden Beitrag werden zunächst allgemeine neuro-intensivmedizinische Therapiekonzepte wie die akute Therapie des erhöhten intrakraniellen Drucks, Beatmungs- und Sedierungskonzepte bei neurologischen Patienten, das erweiterte Neuromonitoring und Blutzucker- und Temperaturmanagement vorgestellt. Im Anschluss werden die speziellen Interventionsmöglichkeiten in Bezug auf die einzelnen Krankheitsbilder – maligner Mediainfarkt, Basilarisverschluss, intrazerebrale Blutungen und Subarachnoidalblutungen – gesondert diskutiert.

Abstract

The prognosis of patients with severe stroke has significantly improved during the last years upon introduction of new therapeutic options and intensive care strategies. The following article focuses on general neuro-intensive care strategies such as treatment of severe brain edema, ventilation- and sedation concepts, blood pressure, serum glucose and temperature management and multimodal neuromonitoring. Additionally, the available evidence for special therapeutic measures such as hemicraniectomy for malignant MCA infarction, thromobolytic therapy in basilar artery occlusion and conservative or operative approaches for intracerebral and subarachnoid hemorrhage will be presented.

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Authors and Affiliations

  1. Neurologische Klinik, Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    J. Diedler & T. Steiner

  2. Neurologische Universitätsklinik Erlangen, Erlangen, Deutschland

    M. Köhrmann

  3. Neurochirurgische Klinik, Charité Universitätsmedizin Berlin, Berlin, Deutschland

    P. Vajkoczy

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  1. J. Diedler
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  2. M. Köhrmann
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  3. P. Vajkoczy
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  4. T. Steiner
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Correspondence to J. Diedler.

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Diedler, J., Köhrmann, M., Vajkoczy, P. et al. Behandlung schwerster Schlaganfälle auf der Intensivstation. Notfall Rettungsmed 11, 183–189 (2008). https://doi.org/10.1007/s10049-008-1044-6

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