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Behandlung der spontanen intrazerebralen Blutung bei älteren Patienten

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Neurochirurgie bei älteren Patienten

Zusammenfassung

Die spontane intrazerebrale Blutung (ICB) ist ein Subtyp des Schlaganfalls und tritt im höheren Lebensalter gehäuft auf. Der klinische Verlauf und das funktionelle Outcome nach spontaner ICB sind abhängig von verschiedenen Faktoren. Speziell im höheren Lebensalter besteht eine höhere Komorbiditätsrate und eine zunehmende Vorbehandlung mit Thrombozytenaggregationshemmern oder oralen Antikoagulanzien. In klinischen randomisierten Studien ist der ältere Patient mit spontaner ICB deutlich unterrepräsentiert, sodass die meisten Ergebnisse dieser Studien nicht direkt auf diese Patienten übertragbar sind. Zusätzliche therapeutische Einschränkungen ergeben sich häufig durch das Vorliegen einer Patientenverfügung. In diesem Kapitel wird die Behandlung der spontanen ICB anhand der aktuellen Literatur und anhand persönlicher Erfahrung diskutiert.

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Literatur

  • Anderson CS, Huang Y, Wang JG, Arima H, Neal B, Peng B et al (2008) Intensive blood pressure reduction in acute cerebral hemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol 7:391–399

    Article  PubMed  Google Scholar 

  • Ariesen MJ, Claus SP, Rinkel GJ, Algra A (2003) Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke 34:2060–2065

    Article  CAS  PubMed  Google Scholar 

  • Baltan S, Besancon EF, Mbow B, Ye Z, Hamner MA, Ransom BR (2008) White matter vulnerability to ischemic injury increases with age because of enhanced excitotoxicity. J Neurosci 28:1479–1489

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bhattathiri PS, Gregson B, Prasad KS, Mendelow AD (2006) Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial. Acta Neurochir Suppl 96:65–68

    Article  CAS  PubMed  Google Scholar 

  • Blackman DK, Kamimoto LA, Smith SM (1999) Overview: surveillance for selected public health indicators affecting older adults – United States. MMWR CDC Surveill Summ 48:1–6

    PubMed  Google Scholar 

  • Broderick JP, Brott T, Tomsick T, Miller R, Huster G (1993) Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg 78:188–191

    Article  CAS  PubMed  Google Scholar 

  • Brott TK, Thalinger K, Hertzberg V (1986) Hypertension as a risk factor for spontaneous intracerebral hemorrhage. Stroke 17:1078–1083

    Article  CAS  PubMed  Google Scholar 

  • Brott T, Broderick J, Kothari R, Barsan W, Tomsick T, Sauerbeck L et al (1997) Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 28:1–5

    Article  CAS  PubMed  Google Scholar 

  • Brown WR, Thore CR (2011) Review: cerebral microvascular pathology in ageing and neurodegeneration. Neuropathol Appl Neurobiol 37:56–74

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Butcher KS, Baird T, MacGregor L, Desmond P, Tress B, Davis S (2004) Perihematomal edema in primary intracerebral hemorrhage is plasma derived. Stroke 35:1879–1885

    Article  PubMed  Google Scholar 

  • Butler AB, Partain RA, Netsky MG (1972) Primary intraventricular haemorrhage. A mild and remediable form. Neurology 22:675–687

    Article  CAS  PubMed  Google Scholar 

  • Demchuk AM, Dowlatshahi D, Rodriguez-Luna D, Molina CA, Blas YS, Dzialowski I et al (2012) Prediction of hematoma growth and outcome in patients with intracerebral hemorrhage using the CT-angiography spot sign (PREDICT): a prospective observational study. Lancet Neurol 11:307–314

    Article  PubMed  Google Scholar 

  • Diringer MN, Edwards DF (2001) Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage. Crit Care Med 29:635–640

    Article  CAS  PubMed  Google Scholar 

  • Firsching R, Huber M, Frowein RA (1991) Cerebellar hemorrhage: management and prognosis. Neurosurg Rev 14:191–194

    Article  CAS  PubMed  Google Scholar 

  • Fisher CM (1971) Pathological observations in hypertensive cerebral hemorrhage. J Neuropathol Exp Neurol 30:536–550

    Article  CAS  PubMed  Google Scholar 

  • Flaherty ML, Woo D, Haverbusch M, Sekar P, Khoury J, Sauerbeck L et al (2005) Racial variations in location and risk of intracerebral hemorrhage. Stroke 36:934–937

    Article  PubMed  Google Scholar 

  • Frontera JA, Lewin JJ 3rd, Rabinstein AA, Aisiku IP, Alexandrov AW, Cook AM et al (2016) Guideline for reversal of antithrombotics in intracranial hemorrhage: executive summary. A statement for healthcare professionals from the Neurocritical Care Society and the Society of Critical Care Medicine. Crit Care Med 44:2251–2257

    Article  PubMed  Google Scholar 

  • Giroud M, Gras P, Chadan N, Beuriat P, Milan C, Arveux P et al (1991) Cerebral hemorrhage in a French prospective population study. J Neurol Neurosurg Psychiaty 54:595–598

    Article  CAS  Google Scholar 

  • Gottesman RF, Kleinman JT, Davis C, Heidler-Gary J, Newhart M, Kannan V et al (2008) Unilateral neglect is more severe and common in older patients with right hemispheric stroke. Neurology 71:1439–1444

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gregory PC, Kuhlemeier KV (2003) Prevalence of venous thromboembolism in acute hemorrhagic and thromboembolic stroke. Am J Phys Med Rehabil 82:364–369

    Article  PubMed  Google Scholar 

  • Hanley DF, Lane K, McBee N, Ziai W, Tuhrim S, Lees KR et al (2017) Thrombolytic removal of intraventricular hemorrhage in treatment of severe stroke: results of the randomized, multicenter, multiregional, placebo-controlled CLEAR III trial. Lancet 389:603–611

    Google Scholar 

  • Hanley JP (2004) Warfarin reversal. J Clin Pathol 57:1132–1139

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC (2001) The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 32:891–897

    Article  PubMed  Google Scholar 

  • Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M et al (2015) Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:2032–2060

    Google Scholar 

  • Hoffman WE, Pelligrino D, Miletich DJ, Albrecht RF (1985) Brain metabolic changes in young vs. aged rats during hypoxia. Stroke 16:860–863

    Article  CAS  PubMed  Google Scholar 

  • Holbrook AS, Schulman S, Witt DM, Vandvik PO, Fish J, Kovacs MJ et al (2012) Evidence-based management of anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of chest physicians evidence-based clinical practice guidelines. Chest 141(2 Suppl):e152S–e184S

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Jackson CA, Sudlow CL (2006) Is hypertension a more frequent risk factor for deep than for lobar supratentorial intracerebral hemorrhage? J Neurol Neurosurg Psychiatry 77:1244–1252

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Jellinger K (1977) Pathology of intracerebral hemorrhage. Zentralbl Neurochir 214:195–206

    CAS  Google Scholar 

  • Jorgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS (1996) Acute stroke with atrial fibrillation. The Copenhagen stroke study. Stroke 27:1765–1769

    Article  CAS  PubMed  Google Scholar 

  • Kelly PJ, Furie KL, Shafqat S, Rallis N, Chang A, Stein J (2003) Functional recovery following rehabilitation after hemorrhagic and ischemic stroke. Arch Phys Med Rehabil 84:968–972

    Article  PubMed  Google Scholar 

  • Lacut K, Bressollette L, Le Gal G, Etienne E, De Tinteniac A, Renault A et al (2005) Prevention of venous thrombosis in patients with acute intracerebral hemorrhage. Neurology 65:865–869

    Article  CAS  PubMed  Google Scholar 

  • Lubetsky A, Hoffman R, Zimlichman R, Eldor A, Zvi J, Kostenko V et al (2004) Efficacy and safety of a prothrombin complex concentrate (Octaplex) for rapid reversal of oral anticoagulation. Thromb Res 113:371–378

    Article  CAS  PubMed  Google Scholar 

  • Lukovits TG, Goddeau RP Jr (2011) Critical care of patients with acute ischemic and hemorrhagic stroke: update on recent evidence and international guidelines. Chest 139:694–700

    Article  PubMed  Google Scholar 

  • Matsumoto N, Whisnant JP, Kurland LT, Okazaki H (1973) Natural history of stroke in Rochester, Minnesota, 1955 through 1969: an extension of a previous study, 1945 through 1954. Stroke 4:20–29

    Article  CAS  PubMed  Google Scholar 

  • Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM (2013) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral hematomas (STICH II): a randomized trial. Lancet 382:397–408

    Article  PubMed  PubMed Central  Google Scholar 

  • Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT et al (2005) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral hematomas in the international surgical trial in intracerebral hemorrhage (STICH): a randomized trial. Lancet 365:387–397

    Article  PubMed  Google Scholar 

  • Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP et al (1978) The Harvard cooperative stroke registry: a prospective registry. Neurology 28:754–762

    Article  CAS  PubMed  Google Scholar 

  • Naff N, Williams MA, Keyl PM, Tuhrim S, Bullock MR, Mayer SA et al (2011) Low-dose recombinant tissue-type plasminogen activator enhances clot resolution in brain hemorrhage: the intraventricular hemorrhage thrombolysis trial. Stroke 42:3009–3016

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Pabinger I, Brenner B, Kalina U, Knaub S, Nagy A, Ostermann H et al (2008) Prothrombin complex concentrate (Beriplex P/N) for emergency anticoagulation reversal: a prospective multinational clinical trial. J Thromb Haemost 6:622–631

    Article  CAS  PubMed  Google Scholar 

  • Qureshi AI, Mohammad YM, Yahia AM, Suarez JI, Siddiqui AM, Kirmani JF et al (2005) A prospective multicenter study to evaluate the feasibility and safety of aggressive antihypertensive treatment in patients with acute intracerebral hemorrhage. J Intensive Care Med 20:34–42

    Article  PubMed  Google Scholar 

  • Rizos T, Dorner N, Jenetzky E, Sykora M, Mundiyanapurath S, Horstmann S (2013) Spot signs in intracerebral hemorrhage: useful for identifying patients at risk for hematoma enlargement? Cerebrovasc Dis 35:582–589

    Article  PubMed  Google Scholar 

  • Rosand J, Eckman MH, Knudsen KA, Singer DE, Greenberg SM (2004) The effect of warfarin and intensity of anticoagulation on outcome of intracerebral hemorrhage. Arch Intern Med 164:880–884

    Article  CAS  PubMed  Google Scholar 

  • Samson RD, Barnes CA (2013) Impact of aging brain circuits on cognition. Eur J Neurosci 37:1903–1915

    Article  PubMed  PubMed Central  Google Scholar 

  • Smith EE, Rosand J, Greenberg SM (2005) Hemorrhagic stroke. Neuroimaging Clin N Am 15:259–272 (ix)

    Article  PubMed  Google Scholar 

  • Stein M, Steiner T, Misselwitz B, Uhl E, Reinges MHT (2016) The very old in randomized surgical intracerebral hemorrhage trails. Limitations induced by upper age limits. Neurol Res Ther 1:5

    Google Scholar 

  • Stein M, Hamann GF, Misselwitz B, Uhl E, Kolodziej M, Reinges MH (2016) In-hospital mortality and complication rates in surgically and conservatively treated patients with spontaneous intracerebral hemorrhage in central Europe: a population-based study. World Neurosurg 88:306–310

    Article  PubMed  Google Scholar 

  • Steiner T, Al-Shahi Salman R, Beer R, Christensen H, Cordonnier C, Csiba L et al (2014) European Stroke Organization (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke 9:840–855

    Article  PubMed  Google Scholar 

  • Thompson BB, Bejot Y, Caso V, Castillo J, Christensen H, Flaherty ML et al (2010) Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review. Neurology 75:1333–1342

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ueda K, Hasuo Y, Kiyohara Y, Wada J, Kawano H, Kato I et al (1988) Intracerebral hemorrhage in a Japanese community, Hisayama: incidence, changing pattern during long-term follow-up, and related factors. Stroke 19:48–52

    Article  CAS  PubMed  Google Scholar 

  • van Loon J, Van Calenbergh F, Goffin J, Plets C (1993) Controversies in the management of spontaneous cerebellar hemorrhage. A consecutive series of 49 cases and review of the literature. Acta Neurochir (Wien) 122:187–193

    Article  Google Scholar 

  • van Straaten EC, Scheltens P, Barkhof F (2004) MRI and CT in the diagnosis of vascular dementia. J Neurol Sci 226:9–12

    Article  PubMed  Google Scholar 

  • Vemmos KN, Tsivgoulis G, Spengos K, Zakopoulos N, Synetos A, Kotsis V et al (2003) Association between 24-h blood pressure monitoring variables and brain oedema in patients with hyperacute stroke. J Hypertens 21:2167–2173

    Article  CAS  PubMed  Google Scholar 

  • Weisberg LA (1979) Computerized tomography in intracranial hemorrhage. Arch Neurol 36:422–426

    Article  CAS  PubMed  Google Scholar 

  • Zubkov A, Wijdicks EF (2009) Deep venous thrombosis prophylaxis in cerebral hemorrhage. Rev Neurol Dis 6:21–25

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland

    Marco Stein

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  1. Marco Stein
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Correspondence to Marco Stein .

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Editors and Affiliations

  1. Neurochirurgische Klinik, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Gießen, Hessen, Germany

    Eberhard Uhl

  2. Klinik für Spinale Chirurgie, Schön Klinik Hamburg Eilbek, Hamburg, Germany

    Karsten Schöller

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Stein, M. (2021). Behandlung der spontanen intrazerebralen Blutung bei älteren Patienten. In: Uhl, E., Schöller, K. (eds) Neurochirurgie bei älteren Patienten. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-60354-3_11

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