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.
Schlüsselwörter
intrazerebrale Blutung - Kavernom - Reblutung - operative Therapie
Keywords
intracerebral hemorrhage - cavernous angioma - rebleeding - surgical therapy
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Dr. med. Carsten Moschner
Städtisches Klinikum Braunschweig, Neurologische Klinik
Salzdahlumer Str. 90
38126 Braunschweig
eMail: c.moschner@klinikum-braunschweig.de