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Akutversorgung des ischämischen Schlaganfalls

Management of acute ischemic stroke

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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 4 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, welche die Versorgung innerhalb der ersten 48 h bestimmen.

Abstract

The management of acute ischemic stroke aims to verify the clinical diagnosis, to start general supportive care and to enable decision-making about specific forms of therapy.

The risk-benefit ratio is time-dependent for many therapeutic options; therefore time delays are a disadvantage within the rescue chain. The trained and multidisciplinary team of the stroke unit forms the backbone of acute management. In addition, technical infrastructure influences therapeutic options and cerebral imaging is the cornerstone.

The following four therapies are evidence-based: treatment on a stroke unit, thrombolysis, early administration of acetylsalicylic acid (ASS) and hemicraniectomy in patients younger than 60 years with a so-called malignant infarction.

This article describes the necessary diagnostic steps and the general and specific therapeutic options that comprise acute management within the first 48 h.

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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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Authors and Affiliations

  1. Klinik für Neurologie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Deutschland

    C.H. Nolte & M. Endres

  2. Centrum für Schlaganfallforschung Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    C.H. Nolte & M. Endres

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  1. C.H. Nolte
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  2. M. Endres
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Correspondence to C.H. Nolte.

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Nolte, C., Endres, M. Akutversorgung des ischämischen Schlaganfalls. Internist 53, 585–594 (2012). https://doi.org/10.1007/s00108-011-3003-4

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  • DOI: https://doi.org/10.1007/s00108-011-3003-4

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