Schlaganfall

Ch. C. Eschenfelder; J. A. Zeller; R. Stingele

doi:10.1055/s-0037-1616975

Hämostaseologie, Table of Contents

Hamostaseologie 2006; 26(04): 298-308
DOI: 10.1055/s-0037-1616975

Research Articles

Schattauer GmbH

Schlaganfall

Ursachen und KlassifikationStroke: causes and classification

Ch. C. Eschenfelder

¹Klinik für Neurologie (Direktor: Prof. Dr. med. Günther Deuschl), Universitätsklinikum Schleswig- Holstein, Campus Kiel

,

J. A. Zeller

¹Klinik für Neurologie (Direktor: Prof. Dr. med. Günther Deuschl), Universitätsklinikum Schleswig- Holstein, Campus Kiel

,

R. Stingele

¹Klinik für Neurologie (Direktor: Prof. Dr. med. Günther Deuschl), Universitätsklinikum Schleswig- Holstein, Campus Kiel

› Author Affiliations

Abstract

Zusammenfassung

Schlaganfälle sind akute Durchblutungsstörungen des Gehirns. Durch Verschluss einer Arterie wird ein Hirninfarkt, durch Ruptur einer Arterie eine Hirnblutung hervorgerufen. Etwa 80% der Schlaganfälle sind ischämischer Natur, 20% sind durch primäre Blutungen hervorgerufen. Die vier großen Gruppen ischämischer Schlaganfall, intrazerebrale Blutungen, Subarachnoidalblutungen und Sinus- bzw. Hirnvenenthrombosen werden anhand ihrer Ursachen und klinischen Besonderheiten charakterisiert. Besondere Beachtung findet die transitorisch-ischämische Attacke (TIA), da das Rezidivschlaganfallrisiko in den ersten Tagen nach TIA stark erhöht ist und lange Zeit unterschätzt wurde. Gängige Klassifikationen zur ätiopathogenetischen Einordnung, der Beurteilung des klinischen Zustands oder des Behandlungsergebnisses werden vorgestellt und diskutiert.

Summary

Cerebrovascular disease is caused by ischaemic stroke, intracerebral haemorrhage, subarachnoidal haemorrhage or cerebral vein and sinus thrombosis. Approximately 80% of all cerebrovascular accidents are caused by ischaemic stroke, whereas 20% are due to primary haemorrhage. This article summarizes the typical causes of each of the four main groups of cerebrovascular disease and points out clinical differences. Special attention is given to transitory ischemic attacks since new reports underline the necessity of early diagnostic and therapeutic intervention. Useful diagnostic and clinical scales are presented and discussed.

Schlüsselwörter

Schlaganfall - Ursachen - Klassifikation

Keywords

Cerebrovascular disease - stroke - aetiology - classification

Full Text

References

Literatur
1 The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke.. International Stroke Trial Collaborative Group. Lancet 1997; 349: 1569-81.
2 Statistisches Jahrbuch. Wiesbaden: Statistisches Bundesamt; 2003
3 Adams Jr HP, Bendixen BH, Kappelle LJ. et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35-41.
4 Adams Jr HP, Gordon DL. Epidemiology of and stroke-preventive strategies for atherothromboembolic brain infarction in the elderly. Clin Geriatr Med 1991; 7: 401-16.
5 Ameri A, Bousser MG. Cerebral venous thromboses. Clinical diagnosis. Ann Radiol (Paris) 1994; 37: 101-7.
6 Ameri A, Bousser MG. Cerebral venous thrombosis. Neurol Clin 1992; 10: 87-111.
7 Bamford JM. Lacunar syndromes – are they still worth diagnosing?. In: Donnan GA, Norrving B, Bamford JM. et al (eds). Lacunar and other subcortical infarctions. Oxford: Universitiy Press; 1995: 32-46.
8 Bogousslavsky J, Cachin C, Regli F. et al. Cardiac sources of embolism and cerebral infarction – clinical consequences and vascular concomitants: the Lausanne Stroke Registry. Neurology 1991; 41: 855-9.
9 Boulanger JM, Coutts SB, Hill MD. et al. Use of magnetic resonance imaging in predicting further vascular events among patients with transient ischemic attacks. Stroke 2005; 36: 526-8.
10 Bousser MG. Cerebral venous thrombosis: diagnosis and management. J Neurol 2000; 247: 252-8.
11 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: 987-93.
12 Brott T, Broderick J, Kothari R. et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 1997; 28: 1-5.
13 Busse O. Einteilung und Skalen. In: Hamann GF, Siebler M, von Scheidt M. (eds). Schlaganfall. Klinik, Diagnostik, Therapie. Landsberg: ecomed; 2002: 268-75.
14 Cantu C, Barinagarrementeria F. Cerebral venous thrombosis associated with pregnancy and puerperium. Review of 67 cases. Stroke 1993; 24: 1880-4.
15 Caplan LR, Goodwin JA. Lateral tegmental brainstem hemorrhages. Neurology 1982; 32: 252-60.
16 Chong JY, Mohr JP. Anticoagulation and platelet antiaggregation therapy in stroke prevention. Curr Opin Neurol 2005; 18: 53-7.
17 Coull AJ, Lovett JK, Rothwell PM. Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. Br Med J 2004; 328: 326.
18 Coutts SB, Hill MD, Simon JE. et al. Silent ischemia in minor stroke and TIA patients identified on MR imaging. Neurology 2005; 65: 513-7.
19 Daffertshofer M, Mielke O, Pullwitt A. et al. Transient ischemic attacks are more than ,,ministrokes“. Stroke 2004; 35: 2453-8.
20 Davalos A, Toni D, Iweins F. et al. Neurological deterioration in acute ischemic stroke: potential predictors and associated factors in the European cooperative acute stroke study (ECASS) I. Stroke 1999; 30: 2631-6.
21 Diener HC, Hacke W, Busch E. Zerebrale Ischämie. In: Brandt T, Dichgans J, Diener C. (eds). Therapie und Verlauf neurologischer Erkrankungen. Stuttgart: Kohlhammer; 2003: 345-76.
22 Einhäupl KM, Masuhr F. Cerebral sinus and venous thrombosis. Ther Umsch 1996; 53: 552-8.
23 Einhäupl KM, Villringer A, Meister W. et al. Heparin treatment in sinus venous thrombosis. Lancet 1991; 338: 597-600.
24 Fisher CM. Hypertensive cerebral hemorrhage. Demonstration of the source of bleeding. J Neuropathol Exp Neurol 2003; 62: 104-7.
25 Fisher CM. A lacunar stroke. The dysarthria-clumsy hand syndrome. Neurology 1967; 17: 614-7.
26 Fisher CM. Lacunar strokes and infarcts: a review. Neurology 1982; 32: 871-6.
27 Fisher CM. The pathologic and clinical aspects of thalamic hemorrhage. Trans Am Neurol Assoc 1959; 84: 56-9.
28 Fisher CM. Pathological observations in hypertensive cerebral hemorrhage. J Neuropathol Exp Neurol 1971; 30: 536-50.
29 Fisher CM. Thalamic pure sensory stroke: a pathologic study. Neurology 1978; 28: 1141-4.
30 Fisher CM, Curry HB. Pure motor hemiplegia. Trans Am Neurol Assoc 1964; 89: 94-7.
31 Gomez C. Time is brain. J Stroke Cerebrovasc Dis 1993; 3: 12.
32 Grau AJ, Weimar C, Buggle F. et al. Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke 2001; 32: 2559-66.
33 Hill MD, Yiannakoulias N, Jeerakathil T. et al. The high risk of stroke immediately after transient ischemic attack: a population-based study. Neurology 2004; 62: 2015-20.
34 Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968; 28: 14-20.
35 Johnston SC, Gress DR, Browner WS. et al. Shortterm prognosis after emergency department diagnosis of TIA. JAMA 2000; 284: 2901-6.
36 Johnston SC, Selvin S, Gress DR. The burden, trends, and demographics of mortality from subarachnoid hemorrhage. Neurology 1998; 50: 1413-8.
37 Jorgensen HS, Nakayama H, Reith J. et al. Stroke recurrence: predictors, severity, and prognosis. The Copenhagen Stroke Study. Neurology 1997; 48: 891-5.
38 Khaw KT. Epidemiology of stroke. J Neurol Neurosurg Psychiatry 1996; 61: 333-8.
39 Kolominsky-Rabas PL, Heuschmann PU. Incidence, etiology and long-term prognosis of stroke. Fortschr Neurol Psychiatr 2002; 70: 657-62.
40 Kolominsky-Rabas PL, Sarti C, Heuschmann PU. et al. A prospective community-based study of stroke in Germany--the Erlangen Stroke Project (ESPro): incidence and case fatality at 1, 3, and 12 months. Stroke 1998; 29: 2501-6.
41 Kolominsky-Rabas PL, Weber M, Gefeller O. et al. Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke 2001; 32: 2735-40.
42 Levine SR. The time man has cometh to brain: tick.death.tick.death.. Stroke 2006; 37: 10.
43 Lipton P. Ischemic cell death in brain neurons. Physiol Rev 1999; 79: 1431-568.
44 Lovett JK, Dennis MS, Sandercock PA. et al. Very early risk of stroke after a first transient ischemic attack. Stroke 2003; 34: e138-40.
45 Mohr JP, Kase CS, Meckler RJ. et al. Sensorimotor stroke due to thalamocapsular ischemia. Arch Neurol 1977; 34: 739-41.
46 Mohr JP, Thompson JL, Lazar RM. et al. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med 2001; 345: 1444-51.
47 Preter M, Tzourio C, Ameri A. et al. Long-term prognosis in cerebral venous thrombosis. Followup of 77 patients. Stroke 1996; 27: 243-6.
48 Rieke K, Schwab S, Krieger D. et al. Decompressive surgery in space-occupying hemispheric infarction: results of an open, prospective trial. Crit Care Med 1995; 23: 1576-87.
49 Rother J, Waggie K, van Bruggen N. et al. Experimental cerebral venous thrombosis: evaluation using magnetic resonance imaging. J Cereb Blood Flow Metab 1996; 16: 1353-61.
50 Rothwell PM, Giles MF, Flossmann E. et al. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet 2005; 366: 29-36.
51 Rothwell PM, Johnston SC. Transient ischemic attacks: stratifying risk. Stroke 2006; 37: 320-2.
52 Saver JL. Time is brain--quantified. Stroke 2006; 37: 263-6.
53 Strupp M, Covi M, Seelos K. et al. Cerebral venous thrombosis: correlation between recanalization and clinical outcome--a long-term follow-up of 40 patients. J Neurol 2002; 249: 1123-4.
54 Sudlow CL, Warlow CP. Comparable studies of the incidence of stroke and its pathological types: results from an international collaboration. International Stroke Incidence Collaboration. Stroke 1997; 28: 491-9.
55 Wolfe CD, Giroud M, Kolominsky-Rabas P. et al. Variations in stroke incidence and survival in 3 areas of Europe. European Registries of Stroke (EROS) Collaboration. Stroke 2000; 31: 2074-9.