Intrazerebrale Blutungen – ein Update

Die intrazerebrale Blutung ist ein neurologischer Notfall, der durch die Ruptur eines intrakraniellen Blutgefäßes ausgelöst wird. Die intrazerebrale Blutung trägt wesentlich zur hohen Mortalität und Morbidität neurovaskulärer Erkrankungen bei. Ungefähr 15% aller Schlaganfälle sind intrazerebrale Blutungen, die Inzidenz hat in den letzten Jahren zugenommen. Die Symptome der intrazerebralen Blutung gleichen meist denen eines akuten ischämischen Schlaganfalls; die Unterscheidung ist nur mittels Bildgebung möglich.

Kernaussagen

• Lange Zeit herrschte Pessimismus und Nihilismus bezüglich der Behandlung und Prognose der intrazerebralen Blutung. Seit 2023 haben jedoch mehrere große, randomisierte klinische Studien positive Ergebnisse für verschieden Aspekte der intrazerebralen Blutung gezeigt und das Feld revolutioniert:

  • Die Behandlung sollte von erfahrenen Teams und gemäß standardisierten Algorithmen ablaufen („ICH Care Bundles“ bzw. „CODE ICH“).

  • Kernpunkte der Behandlung sind die Blutdruckkontrolle, gegebenenfalls Revertierung der Antikoagulation und interdisziplinäre Behandlung zusammen mit der Neurochirurgie.

  • Die minimalinvasive Hämatomevakuation konnte in einer ersten (hochselektionierten) Patientenpopulation in einer randomisierten Studie ein besseres Outcome zeigen. Weitere Studien laufen aktuell.

  • Die dekompressive Hemikraniektomie ist eine Therapieoption für Patienten mit großen, raumfordernden Basalganglienblutungen, jedoch überlegeben die Patienten meist mit schweren Behinderungen.

  • Die Revertierung einer Antikoagulation sollte mit einem spezifischen Medikament erfolgen

    • Prothrombinkonzentrate (PPSB) für Vitamin-K-Antagonisten,

    • Idarucizumab für Dabigatran

    • Andexanet alfa für Apixaban, Edoxaban und Rivaroxaban.

• Die Ätiologie der intrazerebralen Blutung spielt eine entscheidende Rolle für die Rezidivprognose.

• Ein MRT gehört zur Standardabklärung.

Schlüsselwörter

IZB - Neurovaskuläre Erkrankung - häorrhagischer Schlaganfall - Hämatomexpansion - Gehirnblutung

Publication History

Article published online:
06 March 2025

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