Summary
Two sets of comatose stroke-patients were analyzed statistically: 40 patients from the authors' own files and 40 patients from the literature. The strokes were caused by one of the following lesions. Thrombotic or embolic brain artery occlusion; brain hemorrhage from aneurysm or arteriovenous malformation or brain atherosclerosis without demonstrated malformation. The results were as follows:
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1.
For durations of the coma greater than 1 h the survival rate was reduced to less than 50%.
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2.
The slower the development of the coma, the smaller the chance of survival. In patients with slow development of the coma, occlusive vascular disease was found as often as brain hemorrhage.
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3.
As the duration of the coma increased, pneumonia became the main cause of death. Rectal temperature increased parallel with the duration of the coma in cases of brain artery occlusion as well as in cases of brain hemorrhage. This was true whether or not the patient survived.
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4.
Brain hemorrhage showed a higher correlation with elevated blood pressure, and had a poorer immediate prognosis, than thrombotic or embolic vascular occlusion.
In view of the complications which occur in the comatose patient, immediate diagnostic procedures with regard to operative therapy are recommended. Further studies on a larger scale are necessary in which the surgical death rates should be compared with the death rates in the unoperated patients.
Zusammenfassung
Zwei Gruppen von Patienten, die durch Schlaganfall das Bewußtsein verloren hatten, wurden statistisch untersucht: 40 eigene Patienten und 40 Patienten aus Pallbeschreibungen der Literatur. Ursachen des Schlaganfalls waren thrombotische oder embolische Hirnarterienverschlüsse und Hirnmassenblutungen aus Aneurysmen, arteriovenösen Angiomen oder bei Arteriosklerose ohne Nachweis einer Gefäßmißbildung. Die Ergebnisse waren:
Mehr als die Hälfte der Patienten, die länger als 1 Std bewußtlos waren, starben, ohne vorher zu erwachen. Langsame Entstehung der Bewußtlosigkeit hatte eine besonders schlechte Prognose, sowohl bei Blutungen als auch bei Verschlüssen.
Pneumonien waren nach Ablauf von 2 Tagen in steigendem Ausmaß die Todesursache, trotz Intensivpflege. Dementsprechend stieg die Körpertemperatur mit zunehmender Dauer der Bewußtlosigkeit an, sowohl bei Massenblutungen als auch bei Arterienverschlüssen. Zentrales Fieber war von untergeordneter Bedeutung.
Massenblutungen hatten initial eine ungünstigere Prognose als Arterienverschlüsse, jedoch verwischten sich die prognostischen Unterschiede bei längerer Dauer der Bewußtlosigkeit durch das Hinzukommen der Sekundärkomplikationen.
Als Konsequenz wird empfohlen: Rasche Klärung der Diagnose einschließlich Operationsindikation, bevor durch Sekundärkomplikationen Inoperabilität eintritt; großangelegte, teilrandomisierte Studie über Operationsindikationen beim bewußtlosen Schlaganfallpatienten.
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Sindermann, F., Kuntze, W. Bewußtseinsverlust beim Schlaganfall: Diagnose — Verlauf — Prognose. Arch. Psychiat. Nervenkr. 214, 262–277 (1971). https://doi.org/10.1007/BF00342629
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DOI: https://doi.org/10.1007/BF00342629