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Akutversorgung des ischämischen Schlaganfalls

Mit aktuellem Wissen Zeitverzögerungen vermeiden

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Zusammenfassung

Die Akutversorgung des ischämischen Schlaganfalls hat zum Ziel, die Diagnose zu sichern, Basismaßnahmen einzuleiten und die Indikation für spezifische Therapien zu stellen. Das Nutzen-Risiko-Verhältnis ist für viele Therapieoptionen zeitabhängig. Deshalb sind Zeitverzögerungen in der Versorgungskette von Nachteil. Das geschulte, multidisziplinäre Personal der spezialisierten Schlaganfallstation (Stroke-Unit) bildet das Rückgrat der stationären Akutversorgung. Auch technische Möglichkeiten beeinflussen die Therapieoptionen. Eine zentrale Rolle kommt der zerebralen Bildgebung zu. Evidenzbasiert sind folgende Therapien: Behandlung in der Stroke-Unit, Thrombolyse, frühe Gabe von Acetylsalicylsäure sowie die Hemikraniektomie bei unter 60-jährigen Patienten mit malignen Infarkten. In diesem Beitrag werden die notwendige Akutdiagnostik sowie die allgemeinen und spezifischen Therapieoptionen dargestellt, die die Versorgung innerhalb der ersten 48 Stunden bestimmen.

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Author information

Correspondence to Dr. Christian H. Nolte.

Additional information

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung/en hin: Christian H. Nolte hat Vortragshonorare und Reisestipendien von Boehringer Ingelheim und Takeda Pharmaceutical erhalten.

Matthias Endres ist oder war Mitglied der Scientific Advisory Boards des Center of Stroke Research Berlin, Boehringer Ingelheim, Sanofi-Aventis und Merck Sharpe & Dohme; hat Vortragshonorare erhalten von Trommsdorff, GlaxoSmithKline, Bristol-Myers Squibb, AstraZeneca, Boehringer Ingelheim, Pfizer Inc., Berlin-Chemie, Sanofi-Aventis, Bayer Schering Pharma, Takeda Pharmaceutical Company Limited, Desitin Pharmaceuticals GmbH und Novartis; ist Mitglied im Editorial Board von Stroke, dem Journal of Cerebral Blood Flow Metabolism, Cerebrovascular Disease, dem Journal of Molecular Medicine und Neuropsychopharmacology.

Beide Autoren bekommen direkt oder indirekt Forschungsgelder von Novartis, AstraZeneca, dem BMBF, der DFG, der EU und der Volkswagen-Stiftung.

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Nolte, C.H., Endres, M. Akutversorgung des ischämischen Schlaganfalls. CME 10, 7–16 (2013). https://doi.org/10.1007/s11298-013-0070-y

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Schlüsselwörter

  • Akuter ischämischer Schlaganfall
  • Hirninfarkt
  • Notfallversorgung
  • Thrombolyse
  • Kraniektomie