Neues zum Schlaganfall

Zusammenfassung

Im Folgenden werden die wichtigsten neuen Erkenntnisse zur Prävention und Behandlung des Schlaganfalls aus den Jahren 2003 und 2004 referiert. In der Primärprävention zeigt sich, dass eine Östrogensubstitution nach der Menopause zu einem erhöhten Schlaganfallrisiko führt. Die wichtigste präventive Maßnahme ist die Behandlung einer Hypertonie und eine orale Antikoagulation bei Patienten mit Vorhofflimmern. Beim akuten Schlaganfall hat sich in der Zwischenzeit die systemische und lokale Thrombolyse bei Patienten die rechtzeitig auf eine Stroke Unit kommen etabliert. Randomisierte Studien zeigen, dass intravenöses Magnesium beim akuten Schlaganfall nicht wirksam ist. In der Sekundärprävention mit Thrombozytenfunktionshemmern wurden Untergruppen von Patienten identifiziert, die von Clopidogrel mehr profitieren als von Azetylsalizylsäure. Die Wirkung von Dipyridamol in der Schlaganfallprävention hat nichts mit der potenziell blutdrucksenkenden Wirkung der Substanz zu tun. Für die vaskuläre Demenz sind Cholinesterasehemmer wie Donepezil und wahrscheinlich auch Galantamin wirksam.

Abstract

This review reports new information about prevention and treatment of stroke gained from publications in 2003 and 2004. Postmenopausal substitution of estrogen increases stroke risk. The most effective treatment options in primary prevention are treatment of high blood pressure in patients with hypertension and anticoagulation in patients with atrial fibrillation. The only available treatment of acute ischemic stroke besides stroke unit care is systemic and local thrombolysis in highly selected patients. Magnesium i. v. is not effective. Most patients with TIA or ischemic stroke will be treated with antiplatelet drugs for secondary prevention. Post-hoc analyses from the CAPRIE trail identified subgroups of high risk patients who benefit from clopidogrel compared to aspirin (diabetics, other major vascular events). The increased benefit of the combination of aspirin plus dipyridamole is not due to any influence of dipyridamole on blood pressure. Cholinesterase inhibitors are also effective in vascular dementia.

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