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Management der intrazerebralen Blutung

Management of intracerebral hemorrhage

  • Leitthema
  • Published:
Intensivmedizin und Notfallmedizin

Zusammenfassung

Trotz einer Inzidenz von jährlich 90.000 Fällen in der Europäischen Union und hoher Mortalitäts- und Invaliditätsraten sind Pathogenese und Pathophysiologie der intrazerebralen Blutung noch immer nicht hinreichend geklärt. Zahlreiche Therapieempfehlungen basieren aufgrund der geringen Anzahl kontrollierter Studien auf theoretischen Überlegungen, Beobachtungen kleiner Patientenkollektive und persönlichen Erfahrungen des behandelnden Arztes. Der vorliegende Beitrag soll unter Berücksichtigung jüngster Studienergebnisse eine Übersicht über die derzeit vorliegenden Therapieempfehlungen bieten. Diese umfasst Blutdruck- und Hirndrucktherapie, hämostaseologische Maßnahmen und neurochirurgische Therapieoptionen sowie sekundärprophylaktische Empfehlungen.

Abstract

Despite an incidence of 90,000 cases per year within the European Union and the high mortality and morbidity rates, the pathogenesis and pathophysiology of intracerebral hemorrhage (ICH) remain elusive. Due to the small number of controlled clinical trials, many therapeutic recommendations rely on hypotheses, observations of small numbers of patients, and the individual experience of the physician in charge. This article is a summary of recent therapeutic recommendations of ICH comprehending therapies of blood pressure, intracerebral pressure, and disturbances of coagulation as well as neurosurgical approaches and prophylactic measures.

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Literatur

  1. Adams HP Jr, Brott TG, Crowell RM et al (1994) Guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 25:1901–1914

    PubMed  Google Scholar 

  2. Albers GW, Amarenco P, Easton JD et al (2004) Antithrombotic and thrombolytic therapy for ischemic stroke: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126: S 483–512

    Article  Google Scholar 

  3. Anderson CS, Huang Y et al (2008) Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol 7(5):391–399

    Article  PubMed  Google Scholar 

  4. Berger AR, Lipton RB, Lesser ML et al (1988) Early seizures following intracerebral hemorrhage: implications for therapy. Neurology 38:1363–1365

    CAS  PubMed  Google Scholar 

  5. Boeer A, Voth E, Henze T, Prange HW (1991) Early heparin therapy in patients with spontaneous intracerebral haemorrhage. J Neurol Neurosurg Psychiatry 54:466–467

    Article  CAS  PubMed  Google Scholar 

  6. Candelise L, Gattinoni M, Bersano A et al (2007) Stroke-unit care for acute stroke patients: an observational follow-up study. Lancet 369:299–305

    Article  PubMed  Google Scholar 

  7. Diringer MN, Edwards DF (2001) Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage. Crit Care Med 29:635–640

    Article  CAS  PubMed  Google Scholar 

  8. Dunne JW, Chakera T, Kermode S (1987) Cerebellar haemorrhage – diagnosis and treatment: a study of 75 consecutive cases. Q J Med 64:739–754

    CAS  PubMed  Google Scholar 

  9. Feigin VL, Anderson N, Rinkel GJ et al (2005) Corticosteroids for aneurysmal subarachnoid haemorrhage and primary intracerebral haemorrhage. Cochrane Database Syst Rev:CD 004583

    Google Scholar 

  10. Fiebach JB, Schellinger PD, Gass A et al (2004) Stroke magnetic resonance imaging is accurate in hyperacute intracerebral hemorrhage: a multicenter study on the validity of stroke imaging. Stroke 35:502–506

    Article  PubMed  Google Scholar 

  11. Hacke W, Kaste M, Bogousslavsky J et al (2003) European stroke initiative recommendations for stroke management-update 2003. Cerebrovasc Dis 16:311–337

    Article  Google Scholar 

  12. Huttner HB, Schellinger PD, Hartmann M et al (2006) Hematoma growth and outcome in treated neurocritical care patients with intracerebral hemorrhage related to oral anticoagulant therapy: comparison of acute treatment strategies using vitamin K, fresh frozen plasma, and prothrombin complex concentrates. Stroke 37:1465–1470

    Article  CAS  PubMed  Google Scholar 

  13. Mayer SA, Brun NC, Begtrup K et al (2005) Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 352:777–785

    Article  CAS  PubMed  Google Scholar 

  14. Mendelow AD, Gregson BA, Fernandes HM et al (2005) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 365:387–397

    PubMed  Google Scholar 

  15. Morgenstern LB (2004) Medical therapy of intracerebral and intraventricular hemorrhage. In: Mohr JP, Choi DC, Grotta JC et al (eds) Stroke: pathophysiology, diagnosis and management. Churchill Livingstone, Philadelphia, pp 1079–1087

  16. Passero S, Rocchi R, Rossi S et al (2002) Seizures after spontaneous supratentorial intracerebral hemorrhage. Epilepsia 43:1175–1180

    Article  PubMed  Google Scholar 

  17. Qureshi AI, Tuhrim S, Broderick JP et al (2001) Spontaneous intracerebral hemorrhage. N Engl J Med 344:1450–1460

    Article  CAS  PubMed  Google Scholar 

  18. Righetti E, Celani MG, Cantisani T et al (2004) Glycerol for acute stroke. Cochrane Database Syst Rev:CD 000096

    Google Scholar 

  19. Ringleb PA, Bertram M, Keller E, Hacke W (1998) Hypertension in patients with cerebrovascular accident. To treat or not to treat? Nephrol Dial Transplant 13:2179–2181

    Article  CAS  PubMed  Google Scholar 

  20. Ropper A (1986) Lateral displacement of the brain and level of consciousness in patients with acute hemispherical mass. N Engl J Med 314:953–958

    Article  CAS  PubMed  Google Scholar 

  21. Rosand J, Eckman MH, Knudsen KA et al (2004) The effect of warfarin and intensity of anticoagulation on outcome of intracerebral hemorrhage. Arch Intern Med 164:880–884

    Article  CAS  PubMed  Google Scholar 

  22. Rose JC, Mayer SA (2004) Optimizing blood pressure in neurological emergencies. Neurocrit Care 1:287–299

    Article  PubMed  Google Scholar 

  23. Rosner MJ, Rosner SD, Johnson AH (1995) Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 83:949–962

    Article  CAS  PubMed  Google Scholar 

  24. Schwarz S, Schwab S, Bertram M et al (1998) Effects of hypertonic saline hydroxyethyl starch solution and mannitol in patients with increased intracranial pressure after stroke. Stroke 29:1550–1555

    CAS  PubMed  Google Scholar 

  25. Smith EE, Rosand J, Greenberg SM (2005) Hemorrhagic stroke. Neuroimaging Clin N Am 15:259–272

    Article  PubMed  Google Scholar 

  26. Steiner T, Diringer M, Rosand J (2006a) Intracerebral hemorrhage associated with oral anticoagulant therapy: current practices and open questions. Stroke 37:256–262

    Article  CAS  PubMed  Google Scholar 

  27. Steiner T, Schneider D, Mayer S et al (2006b) Dynamics of intraventricular hemorrhage in patients with spontaneous intracerebral hemorrhage: risk factors, clinical impact and effect of hemostatic therapy with recombinant activated factor VII. Neurosurgery 59:767–774

    Article  PubMed  Google Scholar 

  28. Toni D, Chamorro A, Kaste M et al (2004) Acute treatment of ischaemic stroke. European Stroke Initiative. Cerebrovasc Dis 17(Suppl 2):30–46

    Article  PubMed  Google Scholar 

  29. Straaten EC van, Scheltens P, Barkhof F (2004) MRI and CT in the diagnosis of vascular dementia. J Neurol Sci 226:9–12

    Article  PubMed  Google Scholar 

  30. Vespa PM, O’Phelan K, Shah M et al (2003) Acute seizures after intracerebral hemorrhage: a factor in progressive midline shift and outcome. Neurology 60:1441–1444

    CAS  PubMed  Google Scholar 

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

    H. Amiri & T. Steiner

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  1. H. Amiri
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  2. T. Steiner
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Correspondence to H. Amiri.

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Amiri, H., Steiner, T. Management der intrazerebralen Blutung. Intensivmed 47, 156–160 (2010). https://doi.org/10.1007/s00390-009-0119-z

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  • DOI: https://doi.org/10.1007/s00390-009-0119-z

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