Rezidivierende intrazerebrale Blutungen bei jüngeren Erwachsenen – Erst operative Exstirpation beweist Kavernome als Ursache

Zusammenfassung

Wir diskutieren das therapeutische Vorgehen bei spontanen intrazerebralen Blutungen mit initial unklarer Ursache, bei denen kurzfristig signifikante Nachblutungen auftreten. Die Darstellung basiert auf 2 Fallberichten und einer kurzen Literaturübersicht. In beiden Fällen handelte es sich um junge Erwachsene mit initial leichtgradiger Klinik, bei denen eine singuläre supratentorielle intrazerebrale Blutung vorlag. Die Diagnostik einschließlich kranieller Magnetresonanztomografie (cMRT) und digitaler Subtraktionsangiografie (DSA) ergab jeweils keine Blutungsursache. Bei initial leichtgradiger Klinik wurde zunächst konservativ behandelt. Doch es kam innerhalb weniger Wochen zu Rezidivblutungen mit klinischer Verschlechterung, sodass in beiden Fällen nach erneuter Risikoabwägung operativ therapiert wurde. Intraoperativ und histopathologisch fand sich als Blutungsursache in beiden Fällen ein Kavernom. Anhand unserer beiden Fälle diskutieren wir das entsprechende diagnostische und therapeutische Problem.

Abstract

We discuss the treatment of spontaneous intracerebral haemorrhages of unknown aetiology at first presentation that were followed by significant re-bleedings within a few weeks. Two cases and a short overview of the literature are presented. The patients were young adults who initially presented with mild clinical signs, in both cases due to a single supratentorial intracranial haemorrhage. The first diagnostic work-up including cranial MRI and conventional digital subtraction angiography did not reveal the underlying cause of the bleeding. At first, the patients were in a relatively good clinical condition and we decided to treat them non-surgically. However, within a few weeks, both patients were re-admitted with new cerebral bleedings and a clinical deterioration. An individual risk assessment led to a surgical extirpation of the haemorrhages in these patients. The intraoperative aspect and the histopathological examination revealed a single cavernous angioma as the underlying bleeding source. Based on these two cases we discuss the related diagnostic and therapeutic problems.

intrazerebrale Blutung - Kavernom - Reblutung - operative Therapie

intracerebral hemorrhage - cavernous angioma - rebleeding - surgical therapy

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