Zusammenfassung
Die Subarachnoidalblutung gehört zu den neurologischen Notfällen mit intensivmedizinischer
Behandlungsbedürftigkeit. Die Diagnose ist in den überwiegenden Fällen aufgrund der
charakteristischen klinischen Symptome und dem Nachweis von Blut in der zerebralen
Computertomografie oder im Liquor problemlos zu stellen. Bei einigen Patienten verbleibt
jedoch aufgrund der eindeutigen Symptome trotz unauffälliger Befunde in der Routinediagnostik
eine Restunsicherheit. Wir beschreiben die Krankheitsverläufe dreier Patienten, bei
denen die Diagnose einer Subarachnoidalblutung vermutet wurde, obwohl Computertomografie
und Lumbalpunktion einen unauffälligen Befund ergeben hatten. In diesen Fällen konnten
Vasospasmen mittels transkranieller Doppler-Sonografie und/oder ein zerebrales Aneurysma
mittels konventioneller Angiografie nachgewiesen werden. Wir weisen auf die Besonderheiten
dieser seltenen Präsentation einer schwerwiegenden akuten neurologischen Erkrankung
hin, diskutieren differenzialdiagnostische Überlegungen und die Vor- und Nachteile
der einzelnen diagnostischen Schritte.
Abstract
Subarachnoid haemorrhage constitutes a neurological emergency. In most cases the diagnosis
is easy to establish by cerebral computed tomography or cerebrospinal fluid tap. However,
in rare cases verification of the diagnosis is more difficult and a residual uncertainty
remains. We describe three patients supposed to have a subarachnoid haemorrhage without
pathological findings in both cerebral computed tomography and cerebrospinal fluid.
In these cases vasospasm or cerebral aneurysm were detected by means of transcranial
Doppler sonography and/or conventional angiography. We comment on the special features
of this rare presentation of a severe acute neurological emergency, and we discuss
diagnostic work-up and differential diagnoses.
Schlüsselwörter
Subarachnoidalblutung - Liquor - neurologische Intensivmedizin
Keywords
subarachnoid haemorrhage - cerebrospinal fluid - neurological critical care
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Dr. Lothar Burghaus
Klinik und Poliklinik für Neurologie, Universitätsklinik Köln
Kerpener Str. 62
50924 Köln
eMail: lothar.burghaus@uk-koeln.de