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Fortschr Neurol Psychiatr 2015; 83(11): 641-652
DOI: 10.1055/s-0041-108742
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© Georg Thieme Verlag KG Stuttgart · New York

Akutbehandlung des Schlaganfalls

State-of-the-art Treatment of Acute Stroke
R. Weber
1   Klinik für Neurologie, Alfried Krupp Krankenhaus Essen-Rüttenscheid, Essen
,
H. Nordmeyer
2   Klinik für Radiologie und Neuroradiologie, Alfried Krupp Krankenhaus Essen-Rüttenscheid, Essen
› Author Affiliations
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Publication History

Publication Date:
03 December 2015 (online)

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Zusammenfassung

Dieser Artikel gibt einen aktuellen Überblick über die Akutdiagnostik und -behandlung von Patienten mit ischämischem und hämorrhagischem Schlaganfall unter besonderer Darstellung relevanter Studienergebnisse aus den vergangenen 2 Jahren. Als minimale Standardbildgebung sollte bei Patienten mit akutem ischämischem Schlaganfall eine native Computertomografie und CT-Angiografie der hirnversorgenden Gefäße durchgeführt werden, bei Wake-up-Stroke-Patienten hat sich die Kernspintomografie mit Diffusions-/FLAIR-mismatch-Darstellung zur Selektion von Patienten, die von einer Rekanalisierung profitieren können, bewährt. Neben der systemischen Thrombolyse mit rt-PA im 4,5-Stunden-Zeitfenster ist jetzt auch die mechanische Rekanalisation mit Stent-Retrievern bei großen Gefäßverschlüssen der vorderen Hirnzirkulation innerhalb von 6 Stunden eine evidenzbasiert wirksame Methode. Im Gegensatz dazu gibt es in der Behandlung von parenchymatösen Hirnblutungen weiterhin keinen Durchbruch bei den Behandlungsmethoden, hier sollte eine Blutdrucksenkung < 140 mmHg systolisch innerhalb einer Stunde erfolgen. Akute (ischämische und hämorrhagische) Schlaganfall- und TIA-Patienten sollten auf einer Stroke Unit abgeklärt und behandelt werden, wodurch die Prognose verbessert wird. Eine prophylaktische Antibiotikagabe und sehr frühzeitige Mobilisation innerhalb der ersten 24 Stunden sollte bei akuten Schlaganfallpatienten nicht durchgeführt werden.

Abstract

This article gives an overview about diagnostic imaging and treatment options of acute patients with ischemic and hemorrhagic stroke with emphasis on evidence from relevant studies published in the last 2 years. A computed tomography of the brain with CT-angiography should be the minimal standard imaging modality in acute ischemic stroke patients. Diffusion-weighted/imaging-fluid-attenuated inversion recovery (FLAIR)-mismatch magnetic resonance imaging can be useful in patients with wake-up stroke to select patients for recanalisation therapies. Systemic thrombolysis with rt-PA within 4.5 hours after symptom onset and mechanical thrombectomy with stent retrievers within 6 hours and proven occlusion of a large vessel in the anterior brain circulation are both evidence-based treatments. In contrast, there are no major therapeutic advances in patients with hemorrhagic stroke. The systolic blood pressure should be lowered < 140 mmHg in these patients within one hour. Both acute ischemic and hemorrhagic stroke and patients with a transient ischemic attack should be monitored and treated on a stroke unit due to an improved outcome. A prophylactic antibiotic treatment and very early mobilization during the first 24 hours is not recommended in acute stroke patients.

 

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