Aneurysmatische Subarachnoidalblutungen

Die akute Subarachnoidalblutung stellt einen lebensbedrohlichen Notfall mit hoher Morbidität und Letalität dar. Die adäquate präklinische Versorgung und umgehende Einweisung in ein Zentrum der neurovaskulären Maximalversorgung tragen entscheidend zur Prognose der betroffenen Patienten bei.

Kernaussagen

• Die akute Subarachnoidalblutung (SAB) ist eine seltene Form des Schlaganfalls und mit einer hohen Morbidität und Letalität assoziiert.

• Die wichtigsten Risikofaktoren für eine SAB sind:

  • der arterielle Hypertonus,

  • Rauchen und

  • Alkoholkonsum.

• Eine vorherige körperliche Belastung ist nicht entscheidend für das Auftreten einer SAB.

• Die Beurteilung der Vigilanz mittels Glasgow Coma Scale (GCS) sollte sequenziell erhoben werden.

• Die Aufrechterhaltung der zerebralen Perfusion bei gleichzeitiger Vermeidung von Blutdruckspitzen ist essenziell, um Ischämien und Re-Blutungen zu vermeiden.

• Patienten mit aneurysmatischen Subarachnoidalblutungen profitieren von einer zeitnahen Verlegung in ein spezialisiertes neurovaskuläres Zentrum der Maximalversorgung.

• Zur Akutdiagnostik gehören die native cCT, die cCT-Angiografie sowie die digitale Subtraktionsangiografie (DAS).

• Der Verschluss des rupturierten Aneurysmas sollte zeitnah durchgeführt werden und kann durch neurochirurgisches Clipping und endovaskuläre Intervention erfolgen.

Schlüsselwörter

Subarachnoidalblutung - Aneurysma - Clipping - Coiling - Gehirnblutung - zerebrale Blutung - hämorrhagischer Schlaganfall - neurovaskulärer Notfall

Publication History

Article published online:
26 September 2023

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