Advertisement

Der Nervenarzt

, Volume 83, Issue 12, pp 1569–1574 | Cite as

Management intrazerebraler Blutungen

Lernen wir dazu?
  • D. Staykov
  • M. Köhrmann
  • A. Unterberg
Leitthema

Zusammenfassung

Die intrazerebrale Blutung (ICB) ist die schwerste Schlaganfallform. Sie betrifft jährlich ca. 2 Mio. Menschen weltweit und ist mit einer hohen Mortalität und Morbidität vergesellschaftet. Trotz intensiver wissenschaftlicher Erforschung ist es bisher nicht gelungen, eine wirksame Therapie für die ICB zu etablieren. Die Fortschritte in der Kenntnis der zugrunde liegenden Pathomechanismen und ihrer klinischen Bedeutung haben zur Entwicklung neuer therapeutischer Ansätze beigetragen. Aktuell werden operative Verfahren, das aggressive Blutdruckmanagement und die intraventrikuläre Fibrinolyse bei zusätzlichem Vorliegen schwerer Ventrikelblutungen in großen klinischen Phase-III-Studien untersucht.

Schlüsselwörter

Intrazerebrale Blutung Perihämorrhagisches Ödem Intraventrikuläre Blutung Blutdruckmanagement Intraventrikuläre Fibrinolyse 

Management of intracerebral hemorrhage

Can we still learn something?

Summary

Intracerebral hemorrhage (ICH) is the most devastating form of stroke. It affects approximately 2 million people worldwide every year and is a major cause of mortality and morbidity. Despite the focus of intensive scientific research on ICH for decades there is still no proven treatment strategy for this disease. Advances in knowledge on the underlying pathomechanisms of ICH and the clinical impact have contributed to the development of novel treatment approaches. Currently, surgical treatment, aggressive blood pressure management and intraventricular fibrinolysis in patients with additional severe intraventricular hemorrhage are being investigated in large scale phase III clinical trials.

Keywords

Intracerebral hemorrhage Perihemorrhagic edema Intraventricular hemorrhage Blood pressure management Intraventricular fibrinolysis 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Adeoye O, Broderick JP (2010) Advances in the management of intracerebral hemorrhage. Nat Rev Neurol 6:593–601PubMedCrossRefGoogle Scholar
  2. 2.
    Asch CJ van et al (2010) Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 9:167–176PubMedCrossRefGoogle Scholar
  3. 3.
    Keep RF, Hua Y, Xi G (2012) Intracerebral haemorrhage: mechanisms of injury and therapeutic targets. Lancet Neurol (in press)Google Scholar
  4. 4.
    Staykov D et al (2010) Novel approaches to the treatment of intracerebral haemorrhage. Int J Stroke 5:457–465PubMedCrossRefGoogle Scholar
  5. 5.
    Brott T, Thalinger K, Hertzberg V (1986) Hypertension as a risk factor for spontaneous intracerebral hemorrhage. Stroke 17:1078–1083PubMedCrossRefGoogle Scholar
  6. 6.
    Thrift AG, Donnan GA, McNeil JJ (1995) Epidemiology of intracerebral hemorrhage. Epidemiol Rev 17:361–381PubMedGoogle Scholar
  7. 7.
    Flaherty ML (2010) Anticoagulant-associated intracerebral hemorrhage. Semin Neurol 30:565–572PubMedCrossRefGoogle Scholar
  8. 8.
    Broderick JP et al (1993) Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 24:987–993PubMedCrossRefGoogle Scholar
  9. 9.
    Daverat P et al (1991) Death and functional outcome after spontaneous intracerebral hemorrhage. A prospective study of 166 cases using multivariate analysis. Stroke 22:1–6PubMedCrossRefGoogle Scholar
  10. 10.
    Tuhrim S et al (1995) Validation and comparison of models predicting survival following intracerebral hemorrhage. Crit Care Med 23:950–954PubMedCrossRefGoogle Scholar
  11. 11.
    Davis SM et al (2006) Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology 66:1175–1181PubMedCrossRefGoogle Scholar
  12. 12.
    Steiner T et al (2006) 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(4):767–774PubMedCrossRefGoogle Scholar
  13. 13.
    Diringer MN, Edwards DF, Zazulia AR (1998) Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage. Stroke 29:1352–1357PubMedCrossRefGoogle Scholar
  14. 14.
    Qureshi AI et al (2001) Quantitative analysis of injured, necrotic, and apoptotic cells in a new experimental model of intracerebral hemorrhage. Crit Care Med 29:152–157PubMedCrossRefGoogle Scholar
  15. 15.
    Lusardi TA et al (2004) Effect of acute calcium influx after mechanical stretch injury in vitro on the viability of hippocampal neurons. J Neurotrauma 21:61–72PubMedCrossRefGoogle Scholar
  16. 16.
    Qureshi AI, Mendelow AD, Hanley DF (2009) Intracerebral haemorrhage. Lancet 373:1632–1644PubMedCrossRefGoogle Scholar
  17. 17.
    Zazulia AR et al (1999) Progression of mass effect after intracerebral hemorrhage. Stroke 30:1167–1173PubMedCrossRefGoogle Scholar
  18. 18.
    Brott T et al (1997) Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 28:1–5PubMedCrossRefGoogle Scholar
  19. 19.
    Almandoz JE et al (2010) The spot sign score in primary intracerebral hemorrhage identifies patients at highest risk of in-hospital mortality and poor outcome among survivors. Stroke 41:54–60CrossRefGoogle Scholar
  20. 20.
    Xi G, Keep RF, Hoff JT (2006) Mechanisms of brain injury after intracerebral haemorrhage. Lancet Neurol 5:53–63PubMedCrossRefGoogle Scholar
  21. 21.
    Staykov D et al (2011) Natural course of perihemorrhagic edema after intracerebral hemorrhage. Stroke 42:2625–2629PubMedCrossRefGoogle Scholar
  22. 22.
    Bhattathiri PS et al (2006) Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial. Acta Neurochir Suppl 96:65–68PubMedCrossRefGoogle Scholar
  23. 23.
    Staykov D et al (2011) Prognostic significance of third ventricle blood volume in intracerebral haemorrhage with severe ventricular involvement. J Neurol Neurosurg Psychiatry 82:1260–1263PubMedCrossRefGoogle Scholar
  24. 24.
    Wang YC et al (2002) Tissue plasminogen activator for the treatment of intraventricular hematoma: the dose-effect relationship. J Neurol Sci 202:35–41PubMedCrossRefGoogle Scholar
  25. 25.
    Staykov D et al (2009) Intraventricular fibrinolysis and lumbar drainage for ventricular hemorrhage. Stroke 40:3275–3280PubMedCrossRefGoogle Scholar
  26. 26.
    Mayer SA et al (2005) Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 352:777–785PubMedCrossRefGoogle Scholar
  27. 27.
    Mayer SA et al (2008) Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 358:2127–2137PubMedCrossRefGoogle Scholar
  28. 28.
    Mayer SA et al (2009) Can a subset of intracerebral hemorrhage patients benefit from hemostatic therapy with recombinant activated factor VII? Stroke 40:833–840PubMedCrossRefGoogle Scholar
  29. 29.
    Morgenstern LB et al (2010) Guidelines for the management of spontaneous intracerebral hemorrhage. A guideline for healthcare professionals from the american heart association/american stroke association. Stroke 41:2108–2129PubMedCrossRefGoogle Scholar
  30. 30.
    Zhou W et al (2011) Hemostatic therapy in experimental intracerebral hemorrhage associated with the direct thrombin inhibitor dabigatran. Stroke 42:3594–3599PubMedCrossRefGoogle Scholar
  31. 31.
    Kim-Han JS et al (2006) Perihematomal mitochondrial dysfunction after intracerebral hemorrhage. Stroke 37:2457–2462PubMedCrossRefGoogle Scholar
  32. 32.
    Powers WJ et al (2001) Autoregulation of cerebral blood flow surrounding acute (6–22 hours) intracerebral hemorrhage. Neurology 57:18–24PubMedCrossRefGoogle Scholar
  33. 33.
    Prabhakaran S, Naidech AM (2012) Ischemic brain injury after intracerebral hemorrhage: a critical review. Stroke 43:2258–2263PubMedCrossRefGoogle Scholar
  34. 34.
    Mendelow AD 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 365:387–397PubMedGoogle Scholar
  35. 35.
    Gregson BA et al (2012) Individual patient data subgroup meta-analysis of surgery for spontaneous supratentorial intracerebral hemorrhage. Stroke 43:1496–1504PubMedCrossRefGoogle Scholar
  36. 36.
    Prasad K, Mendelow AD, Gregson B (2009) Surgery for primary supratentorial intracerebral hematoma. A meta-analysis of 10 randomized controlled trials. Stroke 24. [Epub ahead of print]Google Scholar
  37. 37.
    Hattori N et al (2004) Impact of stereotactic hematoma evacuation on activities of daily living during the chronic period following spontaneous putaminal hemorrhage: a randomized study. J Neurosurg 101:417–420PubMedCrossRefGoogle Scholar
  38. 38.
    Wang WZ et al (2009) Minimally invasive craniopuncture therapy vs. conservative treatment for spontaneous intracerebral hemorrhage: results from a randomized clinical trial in China. Int J Stroke 4:11–16PubMedCrossRefGoogle Scholar
  39. 39.
    Chen X et al (2011) Frameless stereotactic aspiration and subsequent fibrinolytic therapy for the treatment of spontaneous intracerebral haemorrhage. Br J Neurosurg 25:369–375PubMedCrossRefGoogle Scholar
  40. 40.
    Gaab MR (2011) Intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH): improvement of bad prognosis by minimally invasive neurosurgery. World Neurosurg 75:206–208PubMedCrossRefGoogle Scholar
  41. 41.
    Kuo LT et al (2011) Early endoscope-assisted hematoma evacuation in patients with supratentorial intracerebral hemorrhage: case selection, surgical technique, and long-term results. Neurosurg Focus 30:E9PubMedCrossRefGoogle Scholar
  42. 42.
    Lin HL et al (2010) Endoscopic evacuation of hypertensive putaminal hemorrhage guided by the 3D reconstructed CT scan: a preliminary report. Clin Neurol Neurosurg 112:892–896PubMedCrossRefGoogle Scholar
  43. 43.
    Wagner I et al (2011) Effects of continuous hypertonic saline infusion on perihemorrhagic edema evolution. Stroke 42:1540–1545PubMedCrossRefGoogle Scholar
  44. 44.
    Chen Z et al (2011) Role of iron in brain injury after intraventricular hemorrhage. Stroke 42:465–470PubMedCrossRefGoogle Scholar
  45. 45.
    Selim M et al (2011) Safety and tolerability of deferoxamine mesylate in patients with acute intracerebral hemorrhage. Stroke 42:3067–3074PubMedCrossRefGoogle Scholar
  46. 46.
    Fingas M et al (2009) Treatment of intracerebral hemorrhage in rats with 12 h, 3 days and 6 days of selective brain hypothermia. Exp Neurol 219:156–162PubMedCrossRefGoogle Scholar
  47. 47.
    Kawanishi M et al (2008) Effect of delayed mild brain hypothermia on edema formation after intracerebral hemorrhage in rats. J Stroke Cerebrovasc Dis 17:187–195PubMedCrossRefGoogle Scholar
  48. 48.
    MacLellan CL et al (2006) The influence of hypothermia on outcome after intracerebral hemorrhage in rats. Stroke 37:1266–1270PubMedCrossRefGoogle Scholar
  49. 49.
    Kollmar R et al (2010) Hypothermia reduces perihemorrhagic edema after intracerebral hemorrhage. Stroke 41:1684–1689PubMedCrossRefGoogle Scholar
  50. 50.
    Kollmar R et al (2012) Cooling in intracerebral hemorrhage (CINCH) trial: protocol of a randomized German-Austrian clinical trial. Int J Stroke 7:168–172PubMedCrossRefGoogle Scholar
  51. 51.
    Adams RE, Diringer MN (1998) Response to external ventricular drainage in spontaneous intracerebral hemorrhage with hydrocephalus. Neurology 50:519–523PubMedCrossRefGoogle Scholar
  52. 52.
    Staykov D et al (2010) Intraventricular fibrinolysis for intracerebral hemorrhage with severe ventricular involvement. Neurocrit Care 15:194–209CrossRefGoogle Scholar
  53. 53.
    Orakcioglu B, Yozumi Y, Unterberg A (2011) Endoscopic intra-hematomal evacuation of intracerebral hematomas - a suitable technique for patients with coagulopathies. Acta Neurochir Suppl 112:3–8PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Neurologische KlinikUniversitätsklinikum ErlangenErlangenDeutschland
  2. 2.Neurochirurgische KlinikUniversitätsklinikum HeidelbergHeidelbergDeutschland

Personalised recommendations