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Der Nervenarzt

, Volume 90, Issue 4, pp 423–441 | Cite as

Atypische intrazerebrale Blutungen – Ätiologie und Akutmanagement

  • J. C. Purrucker
  • T. SteinerEmail author
CME
  • 849 Downloads

Zusammenfassung

Akutmanagement und Aufarbeitung der Ursachen intrazerebraler Blutungen stellen Kliniker weiterhin vor Herausforderungen. Allein aufgrund der Lokalisation der Blutung („typisch vs. atypisch“) sollte nicht auf die Genese geschlossen werden, da auch „atypisch“ gelegene Blutungen durch eine langjährige arterielle Hypertonie verursacht werden können, wie auch „typisch“ gelegene Blutungen Folge einer „nichthypertensiven“ Ursache sein können. Neben der Diskussion der Einteilung fokussiert dieser Beitrag auf eine Darstellung eines diagnostischen Algorithmus sowie möglicher (seltener) Ursachen für nichttraumatische intrazerebrale Blutungen. Ebenso wird das Management von Blutungen mit besonderem Schwerpunkt auf aktuelle Daten zum Blutdruckmanagement und zum Vorgehen bei Blutungen unter oraler Antikoagulation dargestellt.

Schlüsselwörter

Blutungsursachen Schlaganfall Antikoagulation Diagnostik Therapie 

Atypical intracerebral hemorrhage—etiology and acute management

Abstract

Acute management as well as establishing the etiology of an intracerebral hemorrhage is still a challenge for clinicians. The location of the intracerebral hemorrhage alone should not be used to determine the cause because atypically located hemorrhages can be caused by long-standing arterial hypertension and typically located hemorrhages can occur due to non-hypertensive causes. Besides discussing the classification of intracerebral hemorrhages, this article focuses on a diagnostic algorithm as well as the presentation of potential (rarer) causes of non-traumatic intracerebral hemorrhages. Furthermore, the acute treatment of intracerebral hemorrhage with respect to recent data on blood pressure management as well as the management of bleeding under oral anticoagulant treatment are described.

Keywords

Bleeding cause Stroke Anticoagulation Diagnostics Treatment 

Notes

Danksagung

Mit Dank an Alessa Weber, Assistenzärztin Klinikum Frankfurt Höchst, für die Fallvignette.

Einhaltung ethischer Richtlinien

Interessenkonflikt

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Autoren

J. Purrucker gibt an, Forschungsförderung erhalten zu haben von: Pfizer (Sachspende). Er hat als Referent ein Honorar oder als passiver Teilnehmer eine Kostenerstattung (Reise- oder Übernachtungskosten, bezahlte Teilnehmergebühren) erhalten von: Boehringer Ingelheim (Reisekostenunterstützung, Vortragshonorar). Er ist bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger o. ä. gewesen für: Akcea (Advisory Board). Nichtfinanzielle Interessen: Oberarzt, Angestellt, Universitätsklinikum Heidelberg, Neurologische Klinik, Heidelberg; Mitgliedschaft thematisch relevant DGN, ESO, WSO. T. Steiner gibt an, Forschungsförderung erhalten zu haben von: Octapharma (Investigatoren initiierte randomisierte klinische Studie). Er hat als Referent ein Honorar oder als passiver Teilnehmer eine Kostenerstattung (Reise- oder Übernachtungskosten, bezahlte Teilnehmergebühren) erhalten von: BMS Pfizer, Bayer, Boehringer, Daiichy Sankyo und Octapharma. Er ist bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger o. ä. gewesen für: BMS Pfizer, Bayer, Boehringer und Octapharma. Er bzw. sein Ehepartner/Partner/Kind hält ein Patent/Geschäftsanteile/Aktien von: NovoNordisk. Nichtfinanzielle Interessen: Angestellter Neurologe und Chefarzt der Neurologischen Klinik, Klinikum Frankfurt Höchst, Frankfurt; Wissenschaftlicher Mitarbeiter der Neurologischen Universitätsklinik Heidelberg; Mitglied der ESO, DGN, DSG, WSC; Vorsitzender der Leitlinienkommission der ESO; Mitglied des Board of Directors der ESO.

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Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Neurologische KlinikUniversitätsklinikum HeidelbergHeidelbergDeutschland
  2. 2.Klinikum Frankfurt HöchstFrankfurt a. M.Deutschland

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