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Nervenheilkunde 2007; 26(12): 1115-1122
DOI: 10.1055/s-0038-1626969
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Schattauer GmbH

Die aneurysmatische Subarachnoidalblutung

Diagnostik und interdisziplinäres ManagementAneurysmal subarachnoid hemorrhageDiagnostic and interdisciplinary management
R. Schmid-Elsaesser
1   Neurochirurgische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität, München
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Publication History

Publication Date:
22 January 2018 (online)

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Zusammenfassung

Zerebrale Aneurysmen sind die häufigste Ursache der Subarachnoidalblutung. Im Durchschnitt werden 30% der Patienten mit Subarachnoidalblutung (SAB) initial fehldiagnostiziert. Die häufigsten Ursachen für Fehldiagnosen sind: 1. Fehlende Kenntnis des klinischen Spektrums. 2. Falsche Interpretation der Bildgebung. 3. Falsche Interpretation der Lumbalpunktion. Bei jedem Patienten mit akutem Kopfschmerz bisher unbekannter Qualität muss eine SAB ausgeschlossen werden. Aufgrund der möglichen Komplikationen sollte eine Lumbalpunktion nicht als primäre Diagnostik durchgeführt werden. Die Computertomografie stellt auch heute noch die Standardmethode für den Nachweis einer akuten SAB dar und sollte bei klinischem Verdacht unverzüglich erfolgen. Für die Aneurysmabehandlung stehen uns heute zwei Methoden zur Verfügung: Die operative Versorgung mittels Clipping und die endovaskuläre mittels Coiling. Die Entscheidung zwischen den Methoden sollte von einem interdisziplinären Team neurovaskulärer Spezialisten getroffen werden, das alle relevanten Faktoren individuell berücksichtigt. In 80% der Fälle bietet eine der beiden Methoden einen klaren Vorteil und sollte dem Patienten angeboten werden. Dies ist nur möglich wenn beide Modalitäten mit hoher Expertise von der behandelnden Institution vorgehalten werden.

Summary

Cerebral aneurysms are the most common cause of subarachnoid hemorrhage (SAH). On average 30% of patients with SAH are initially misdiagnosed. The most common causes of misdiagnoses are: 1. Failure to appreciate the spectrum of clinical presentation. 2. Failure to understand the limitations of imaging. 3. Failure to correctly interpret the results of lumbar puncture. In any patient with acute headache of hitherto unknown quality an SAH has to be ruled out. On account possible complications a lumbar puncture should not primarily be performed. Computed tomography is still the method of choice to detect acute SAH and should immediately be performed when SAH is suspected. Today we have two methods to treat aneurysms: Surgical clipping and endovascular coiling. The decision on the method should be made by an interdisciplinary team of neurovascular specialists who consider all relevant factors individually. In 80% of the cases one method has a clear advantage and should be offered to the patient. This is only possible if both modalities are established with high expertise in the treating institution.

Schlüsselwörter

Subarachnoidalblutung - zerebrales Aneurysma - Diagnostik - neurochirurgische Therapie - endovaskuläre Therapie

Keywords

Subarachnoid hemorrhage - cerebral aneurysm - diagnostic - neurosurgical therapy - endovascular therapy
 

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