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Spezielle Therapie bei Subarachnoidalblutung

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Die Notfalltherapie und Intensivtherapie bei Schlaganfall

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Summary

Despie substantial improvement in the management of patients with aneurysmal subarachnoid hemorrhage (SAH), including early aneurysm sugery, endovascular techniques, and neurointensive care, a significant percentage of patients with SAH still experience serious sequelae of cognitie and/or focal neurological deficits as a result of the primary hemorrhage or secondary complications. Major complications are rebleeding and vasospasm, requiring immediate diagnostic interventions after initial subarachnoid hemorrhage. With an increasing policy of early (within 72h) surgical or endovascular aneurysm obliteration and a subsequent lower risk of rebleeding, vasospam still is a serious complicaiton of SAH, which may lead to permanent focal neurological deficits or cognitive impairment. After confirmation of an aneurysm as the bleeding source, the indication for aneurysm occlusion and type of procedure (surgical versus endovascular) is guided by several factors. Arguments for a surgical intervention in higher-grade patients are the intracerebral clot removal and lavage of the subarachnoid space while an endovascular procedure is favored in elderly patients or patients with endovascular “easy to handle” aneurysms. Today, the decision is still highly, individually dependent on the patient’s neurology, medical condition, aneurysm location and configuration, presence of an intracerebral hemorrhage and the local facilities of the respective department.

Zusammenfassung

Die Subarachnoidalblutung ist ein „medizinischer Notfall“, der trotz verbessertem Management mit friihzeitiger Aneurysmaausschaltung und neurointensivmedizinischer Therapie aufgrund der initialen Blutung oder sekundaren Komplikationen u. U. schwere neurologische Ausfalle nach sich zieht. Die Hauptkomplikationen der SAB sind die Nachblutung und der zerebrale Vasospasmus. Nach initialer Blutung sind sofortige diagnostische Schritte erforderlich. Die sicherste und z. Z. der CT- und MR-Angiographie iiberlegene Methode ist die 4-Gefa13-Angiographie (DAS) zur Aneurysmalokalisation. In Abhangigkeit vom klinischen Zustand des Patienten, seines Alters, der Lokalisation und Konfiguration des Aneurysmas sowie des Vorhandensein einer begleitenden intrazerebralen Blutung wird individuell entschieden, ob eine Aneurysmaausschaltung indiziert ist und welche Therapieform, endovaskular oder chirurgisch, vorzuziehen ist. Wegen heterogener Patientenkollektive liegt bisher keine randomisierte grof3ere Studie vor, die aufgrund geringerer Komplikationen oder eines verbesserten Outcome eine Methode der Aneurysmaausschaltung (chirurgisch oder endovaskular) favorisiert. Die sich stetig verbessernden neuroradiologischen

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Authors and Affiliations

  1. Klinik für Neurochirurgie Charité, Virchow Klinikum Humboldt Universitat Berlin, Augustenburger Platz 1, Berlin, 13353, Germany

    A. W. Unterberg & A. S. Sarrafzadeh

  2. Klinik für Radiologie Charité, Virchow-Klinikum Humboldt-Universitat Berlin, Germany

    G. Benndorf

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  1. A. W. Unterberg
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  2. G. Benndorf
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  3. A. S. Sarrafzadeh
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© 2003 Springer-Verlag Berlin Heidelberg

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Unterberg, A.W., Benndorf, G., Sarrafzadeh, A.S. (2003). Spezielle Therapie bei Subarachnoidalblutung. In: Die Notfalltherapie und Intensivtherapie bei Schlaganfall. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-57384-2_9

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  • DOI: https://doi.org/10.1007/978-3-642-57384-2_9

  • Publisher Name: Steinkopff, Heidelberg

  • Print ISBN: 978-3-7985-1384-6

  • Online ISBN: 978-3-642-57384-2

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