Intrazerebrale Blutung: Update zur Intensivtherapie

Kernaussagen

• Eine intrazerebrale Blutung (ICB) ist ein Notfall, der interdisziplinär behandelt werden sollte.

• Die präklinische Versorgung unterscheidet sich nicht von der eines ischämischen Schlaganfalls.

• Da eine ICB klinisch nicht von einer Ischämie zu unterscheiden ist, darf man in der präklinischen Phase unter keinen Umständen Antikoagulanzien verabreichen.

• In der Klinik sollte man die Verdachtsdiagnose umgehend mit CT oder MRT bestätigen.

• Eine aggressive Blutdrucksenkung auf systolische Werte unter 140 mmHg scheint sicher zu sein.

• ICB haben eine hohe Nachblutungsrate, insbesondere innerhalb der ersten 4 Stunden, die im weiteren Verlauf abnimmt.

• Die Gerinnung sollte man umgehend normalisieren, falls eine relevante Antikoagulation besteht.

• Falls eine intraventrikuläre Blutung aufgetreten ist, sollte man die Anlage einer externen Ventrikeldrainage erwägen.

• In aller Regel entwickelt sich ein perihämorrhagisches Ödem. Trotz fehlender Daten kann man dieses mit Osmotherapeutika behandeln. Eine experimentelle Alternative ist die milde Hypothermie.

• Eine operative Hämatomentfernung kann nicht routinemäßig empfohlen werden. Sie bleibt bislang eine individuelle Entscheidung.

• Zur Thromboseprophylaxe wird der Einsatz von niedermolekularem Heparin 24 Stunden nach ICB empfohlen, sofern eine Nachblutung im CT oder MRT ausgeschlossen ist.

• Literatur

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