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Nervenheilkunde 2008; 27(05): 430-439
DOI: 10.1055/s-0038-1627321
Original- und Übersichtsarbeiten - Original and Review Articles
Schattauer GmbH

Die spontane Subarachnoidalblutung

The spontaneous non-traumatic subarachnoid hemorrhage
F. Dorn
1   Abteilung Neuroradiologie, Klinikum rechts der Isar, Technische Universität München
,
T. Liebig
1   Abteilung Neuroradiologie, Klinikum rechts der Isar, Technische Universität München
,
R. D. Rothoerl
2   Neurochirurgische Klinik im Klinikum rechts der Isar
› Institutsangaben
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Publikationsverlauf

Eingegangen am: 29. November 2007

angenommen am: 30. November 2007

Publikationsdatum:
20. Januar 2018 (online)

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Zusammenfassung

Häufigste Ursache einer nicht traumatischen Subarachnoidalblutung (SAB) ist mit etwa 85% die Ruptur eines Aneurysmas der Hirnbasisarterien. Der plötzlich einsetzende heftige Kopfschmerz (,,Vernichtungskopfschmerz“) ist das Leitsymptom der spontanen SAB. Bei klinischem Verdacht auf eine SAB wird meist eine zerebrale Computertomografie (CCT) veranlasst, in der das subarachnoidale Blut hyperdens in den Liquorräumen zur Darstellung kommt. Nach wie vor gilt die digitale Subtraktionsangiografie (DSA) als Goldstandard beim Nachweis zerebraler Aneurysmen. Sie liefert neben der Aneurysmalokalisation wichtige Informationen bezüglich der Aneurysmakonfiguration und der Lagebeziehung zu angrenzenden Gefäßen, welche die Auswahl des therapeutischen Verfahrens (Coiling oder OP) entscheidend beeinflussen. In der subakuten Phase ist der Patient durch ein verzögert einsetzendes neurologisches Defizit (Vasospasmus), eine Nachblutung oder einen Hydrozephalus gefährdet. Zur Versorgung der Blutungsquelle stehen operative wie auch endovaskuläre Verfahren zur Verfügung. Trotz der Fortschritte in Diagnostik und Therapie ist die Prognose einer aneurysmatischen Subarachnoidalblutung ernst.

Summary

The most common cause for a spontaneous non-traumatic subarachnoid hemorrhage (SAH) is a ruptured aneurysm of the basal cerebral arteries with a frequency of about 85%. The typical symptom is a rapid developing severe headache. Most commonly a computed tomography (CT) is performed in case of a suspected subarachnoid hemorrhage. The CT scan usually reveals hyperdense blood in the basal cisterns. Nevertheless, digital subtraction angiography is the gold standard in order to diagnose a aneurysmatic subarachnoid hemorrhage, because it provides necessary information about aneurysm size shape for the decision how to treat the aneurysm (coiling or clipping). In the subacute phase patients can be harmed by complications such as delayed neurological deficits (e. g. vasospasm), re-bleeding or hydrocephalus. For the treatment of ruptured aneurysms several techniques including endovascular and surgical procedures can be performed. In spite of the progress in the diagnosis and treatment of ruptured aneurysms the prognosis of this disease remains poor.

Schlüsselwörter

SAB - Aneurysma - Clipping - Coiling - Vasospasmus - Nachblutung - Hydrozephalus

Keywords

SAH - aneurysm - clipping - coiling - vasospasm - re-bleeding - hydrocephalus
 

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