Download PDF
Notfallmedizin up2date 2015; 10(1): 45-60
DOI: 10.1055/s-0033-1358117
Spezielle Notfallmedizin
Georg Thieme Verlag KG Stuttgart · New York

Intrazerebrale Blutungen

Jens Kleffmann
,
Christian Roth
,
Ralf Siekmann
,
Wolfgang Deinsberger
Further Information

Publication History

Publication Date:
07 April 2015 (online)

Also available at
   Permissions and Reprints All articles of this category
Kernaussagen

Prinzipiell differenziert man beim Schlaganfall zwischen

  • ischämischen Schlaganfällen (85 %) und

  • Hirnblutungen (ca. 15 %).

Eine Unterscheidung zwischen den beiden Entitäten ist anhand der klinischen Symptome nicht möglich. Der Verdacht auf einen Schlaganfall erfordert eine sofortige Bildgebung des Kopfes zur Differenzierung, da sich die Behandlungskonzepte konträr unterscheiden und die Therapie möglichst früh eingeleitet werden soll: „Time is Brain“.

Bei der Primärversorgung von Patienten mit V. a. ICB oder ischämischen Schlaganfall steht die Sicherung und Stabilisierung der Vitalfunktionen im Vordergrund.

Intrazerebrale Blutungen (ICB) sind trotz moderner Intensivmedizin weiterhin mit einer hohen Mortalitäts- und Komplikationsrate assoziiert.

Bei der ICB besteht die weitere Behandlung in Blutdruckeinstellung, antikonvulsiver, hämostatischer und Hirndrucktherapie, u. U. operativer Therapie.

 

  • Quellenangaben

  • 1 Wolf PA, DʼAgostino RB, OʼNeal MA et al. Secular trends in stroke incidence and mortality. The Framingham Study. Stroke 1992; 23 (11) 1551-1555
    CrossrefGoogle Scholar
  • 2 Kolominsky-Rabas PL, Heuschmann PU, Marschall D et al. Lifetime cost of ischemic stroke in Germany: results and national projections from a population-based stroke registry: the Erlangen Stroke Project. Stroke 2006; 37 (5) 1179-1183
    CrossrefGoogle Scholar
  • 3 Wallesch CW, Janzen RWC, Busse O et al. Organisation der Notaufnahme an Krankenhäusern mit neurologischer Fachabteilung. Akt Neurol 2007; 34 (7) 416-421
    Article in Thieme ConnectGoogle Scholar
  • 4 Sacco S, Marini C, Toni D et al. Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke 2009; 40 (2) 394-399
    CrossrefGoogle Scholar
  • 5 Goldstein LB, Bushnell CD, Adams RJ et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42 (2) 517-584
    CrossrefGoogle Scholar
  • 6 Mendelow AD, Gregson BA, Fernandes HM et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 2005; 365 (9457) 387-397
    CrossrefPubMedGoogle Scholar
  • 7 Mendelow AD, Gregson BA, Rowan EN et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 2013; 382 (9890) 397-408
    CrossrefPubMedGoogle Scholar
  • 8 Morgenstern LB, Hemphill 3rd JC, Anderson C et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2010; 41 (9) 2108-2129
    CrossrefPubMedGoogle Scholar
  • 9 Broderick J, Connolly S, Feldmann E et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group 2007.
    Google Scholar
  • 10 Feigin VL, Lawes CM, Bennett DA et al. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 2009; 8 (4) 355-369
    CrossrefPubMedGoogle Scholar
  • 11 Ariesen MJ, Claus SP, Rinkel GJ et al. Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke 2003; 34 (8) 2060-2065
    CrossrefGoogle Scholar
  • 12 Qureshi AI, Giles WH, Croft JB. Racial differences in the incidence of intracerebral hemorrhage: effects of blood pressure and education. Neurology 1999; 52 (8) 1617-1621
    CrossrefGoogle Scholar
  • 13 Qureshi AI, Suri MF, Nasar A et al. Changes in cost and outcome among US patients with stroke hospitalized in 1990 to 1991 and those hospitalized in 2000 to 2001. Stroke 2007; 38 (7) 2180-2184
    CrossrefPubMedGoogle Scholar
  • 14 Charcot JM, Bouchard C. Nouvelles recherches sur la pathogénie de l hémorrhagie cérébrale. Arch Physiol 1868; 110-127
    Google Scholar
  • 15 Russel RRW. Observations on intracerebral aneurysms. Brain 1963; 86 (3) 425-442
    CrossrefGoogle Scholar
  • 16 Russell RW. Pathological changes in small cerebral arteries causing occlusion and haemorrhage. J Cardiovasc Pharmacol 1984; 6: S691-S695
    CrossrefGoogle Scholar
  • 17 Chung CS, Caplan LR, Han W et al. Thalamic haemorrhage. Brain 1996; 119 (6) 1873-1886
    CrossrefGoogle Scholar
  • 18 Fisher CM. Clinical Syndromes in cerebral Hemorrhage. Springfield: Charles C. Thomas; 1961
    Google Scholar
  • 19 Flaherty ML, Haverbusch M Sekar Pet al. Location and outcome of anticoagulant-associated intracerebral hemorrhage. Neurocrit Care 2006; 5 (3) 197-201
    CrossrefGoogle Scholar
  • 20 Granger CB, Alexander JH, McMurray JJ et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365 (11) 981-992
    CrossrefPubMedGoogle Scholar
  • 21 Caldeira D, Barra M, Pinto FJ et al. Intracranial hemorrhage risk with the new oral anticoagulants: a systematic review and meta-analysis. J Neurol 2014; [Epub ahead of print]
    Google Scholar
  • 22 da Silva IR, Provencio JJ. Intracerebral hemorrhage in patients receiving oral anticoagulation therapy. J Intens Care Med 2015; 30 (2) 63-78
    CrossrefGoogle Scholar
  • 23 Robinson TG, Reid A, Haunton VJ et al. The face arm speech test: does it encourage rapid recognition of important stroke warning symptoms?. Emerg Med J 2013; 30 (6) 467-471
    CrossrefGoogle Scholar
  • 24 Berglund A, Svensson L, Wahlgren N et al. Face arm speech time test use in the prehospital setting, better in the ambulance than in the emergency medical communication center. Cerebrovasc Dis (Basel) 2014; 37 (3) 212-216
    CrossrefGoogle Scholar
  • 25 Nowinski WL, Gomolka RS, Qian G et al. Characterization of intraventricular and intracerebral hematomas in non-contrast CT. Neuroradiol J 2014; 27 (3) 299-315
    Google Scholar
  • 26 Bernhardt J, Dewey H, Thrift A et al. A very early rehabilitation trial for stroke (AVERT) phase ii safety and feasibility. Stroke 2008; 39 (2) 390-396
    CrossrefGoogle Scholar
  • 27 Delcourt C, Huang Y, Arima H et al. Hematoma growth and outcomes in intracerebral hemorrhage: the INTERACT1 study. Neurology 2012; 79 (4) 314-319
    CrossrefGoogle Scholar
  • 28 Davis SM, Broderick J, Hennerici M et al. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology 2006; 66 (8) 1175-1181
    CrossrefGoogle Scholar
  • 29 Diringer MN, Edwards DF. Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage. Crit Care Med 2001; 29 (3) 635-640
    CrossrefGoogle Scholar
  • 30 Steiner T, Al-Shahi SR, Beer R H et al. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke 2014; 9 (7) 840-855
    CrossrefGoogle Scholar
  • 31 Anderson CS, Huang Y, Wang JG et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol 2008; 7 (5) 391-399
    CrossrefPubMedGoogle Scholar
  • 32 Anderson CS, Heeley E, Huang Y et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med 2013; 368 (25) 2355-2365
    CrossrefPubMedGoogle Scholar
  • 33 Rowe AS, Goodwin H, Brophy GM et al. Seizure prophylaxis in neurocritical care: a review of evidence-based support. Pharmacotherapy 2014; 34 (4) 396-409
    CrossrefGoogle Scholar
  • 34 Brott T, Broderick J, Kothari R et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 1997; 28 (1) 1-5
    CrossrefPubMedGoogle Scholar
  • 35 Levine JM, Snider R, Finkelstein D et al. Early edema in warfarin-related intracerebral hemorrhage. Neurocrit Care 2007; 7 (1) 58-63
    CrossrefGoogle Scholar
  • 36 Steiner T, Böhm M, Dichgans M et al. Recommendations for the emergency management of complications associated with the new direct oral anticoagulants (DOACs), apixaban, dabigatran and rivaroxaban. Clin Res Cardiol 2013; 102 (6) 399-412
    CrossrefGoogle Scholar
  • 37 Flynn RW, MacDonald TM, Murray GD et al. Prescribing antiplatelet medicine and subsequent events after intracerebral hemorrhage. Stroke 2010; 41 (11) 2606-2611
    CrossrefGoogle Scholar
  • 38 Hanley DF. Intraventricular hemorrhage: severity factor and treatment target in spontaneous intracerebral hemorrhage. Stroke 2009; 40 (4) 1533-1538
    CrossrefGoogle Scholar
  • 39 Mendelow AD, Unterberg A. Surgical treatment of intracerebral haemorrhage. Curr Opinion Crit Care 2007; 13 (2) 169-174
    CrossrefGoogle Scholar
  • 40 Moradiya Y, Murthy SB, Newman-Toker DE et al. Intraventricular thrombolysis in intracerebral hemorrhage requiring ventriculostomy: a decade-long real-world experience. Stroke 2014; 45 (9) 2629-2635
    CrossrefGoogle Scholar
  • 41 Gaberel T, Magheru C, Parienti JJ et al. Intraventricular fibrinolysis versus external ventricular drainage alone in intraventricular hemorrhage: a meta-analysis. Stroke 2011; 42 (10) 2776-2781
    CrossrefPubMedGoogle Scholar
  • 42 Morgan T, Awad I, Keyl P et al. Preliminary report of the clot lysis evaluating accelerated resolution of intraventricular hemorrhage (CLEAR-IVH) clinical trial. Acta Neurochir Suppl 2008; 105: 217-220
    Google Scholar
  • 43 Webb AJS, Ullman NL, Mann S et al. Resolution of intraventricular hemorrhage varies by ventricular region and dose of intraventricular thrombolytic: the clot lysis: evaluating accelerated resolution of IVH (CLEAR IVH) program. Stroke 2012; 43 (6) 1666-1668
    CrossrefPubMedGoogle Scholar
  • 44 Jaffe J, Melnychuk E, Muschelli J et al. Ventricular catheter location and the clearance of intraventricular hemorrhage. Neurosurgery 2012; 70 (5) 1258-1263 discussion 1263–1264
    CrossrefGoogle Scholar
  • 45 Mathew P, Teasdale G, Bannan A et al. Neurosurgical management of cerebellar haematoma and infarct. J Neurol Neurosurg Psychiat 1995; 59 (3) 287-292
    CrossrefGoogle Scholar
  • 46 Gregson BA, Broderick JP, Auer LM et al. Individual patient data subgroup meta-analysis of surgery for spontaneous supratentorial intracerebral hemorrhage. Stroke 2012; 43 (6) 1496-1504
    CrossrefGoogle Scholar
  • 47 Roth C, Kästner S, Salehi M et al. Comparison of spontaneous intracerebral hemorrhage treatment in Germany between 1999 and 2009: results of a survey. Stroke 2012; 43 (12) 3212-3217
    CrossrefGoogle Scholar
  • 48 Broderick JP, Brott TG, Duldner JE et al. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 1993; 24 (7) 987-993
    CrossrefGoogle Scholar
  • 49 Hemphill 3rd JC, Bonovich DC, Besmertis L et al. The ICH Score. A simple, reliable grading scale for intracerebral hemorrhage. Stroke 2001; 32 (4) 891-897
    CrossrefPubMedGoogle Scholar