Zusammenfassung
Der Patient mit akutem Schlaganfall ist als vorrangiger Notfall anzusehen. Gleiches gilt wegen der hohen Rezidivgefahr in den ersten 48 h auch für Patienten mit transienter ischämischer Attacke (TIA). Eine unverzügliche Schnittbildgebung ist zur Differenzierung einer ischämischen oder hämorrhagischen Ursache als erster diagnostischer Schritt indiziert. Bei akuter zerebraler Ischämie mit behinderndem Defizit steht nach Ausschluss von Kontraindikationen die unverzügliche Wiederherstellung der zerebralen Perfusion als Therapieprinzip im Vordergrund. Dies erfolgt in der Regel als systemische, im Einzelfall als lokal-intraarterielle Thrombolyse mit oder ohne mechanische Rekanalisationsinstrumente. Der Effekt der Thrombolysetherapie ist höchst zeitsensibel: Je früher die Therapie beginnt, desto höher sind die Chancen für ein gutes Behandlungsergebnis. Die unlängst etablierte Ausweitung des therapeutischen Fensters auf 4,5 h ab Symptombeginn darf keinesfalls zu einer Verzögerung der Akutdiagnostik und Behandlungseinleitung führen! Die Weiterbehandlung auf einer Stroke Unit mit zeitnaher ätiologischer Abklärung des Schlaganfalls, Einleitung einer adäquaten Sekundärprophylaxe sowie Behandlung eintretender Komplikationen und frühzeitiger symptomspezifischer Übungstherapie ist nachweislich von hoher Ergebnisrelevanz.
Abstract
Acute stroke must be considered as an emergency with highest priority. The same is true for patients with transient ischemic attacks, given their high risk for following stroke events within the first 48 hours. Early brain imaging is essential for discrimination of either ischemic or hemorrhagic stroke. In acute ischemic stroke, rapid establishment of reperfusion is the major therapeutic goal. This is achieved by intravenous thrombolysis, in selected cases by an intraarterial approach with pharmaceutical and/or mechanical recanalization. The effect of successful reperfusion is highly dependent on time: the earlier, the better the odds for substantial clinical improvement. The recent extension of the time window for systemic thrombolysis to 4.5 hours must not result in any delays of diagnosis and treatment initiation! Stroke units with facilities for early etiological workup with according secondary prevention measures, for prevention and treatment of complications, and for early rehabilitation have been shown to yield the best outcome for all stroke victims.
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Lichy, C., Hacke, W. Schlaganfall. Internist 51, 1003–1012 (2010). https://doi.org/10.1007/s00108-009-2540-6
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DOI: https://doi.org/10.1007/s00108-009-2540-6