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Neurochirurgie Scan 2015; 03(03): 227-238
DOI: 10.1055/s-0034-1389814
Fortbildung
Neurochirurgische Intensivmedizin und Neurotraumatologie
© Georg Thieme Verlag KG Stuttgart · New York

Intrazerebrale Blutung: Update zur Intensivtherapie[*]

Rainer Kollmar
,
Andreas Unterberg
,
Thorsten Steiner
Further Information

Publication History

Publication Date:
29 July 2015 (online)

Also available at
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Zusammenfassung

Die Behandlung einer intrazerebralen Blutung ist immer eine klinische Herausforderung. Dabei sind zahlreiche therapeutische Entscheidungen zu treffen, die einen entscheidenden Einfluss auf das Überleben und das Langzeitergebnis der Patienten haben.

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.

* Erstveröffentlichung des Beitrags in: Intensivmedizin up2date 2014; 10: 153 – 166


 

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