Neurologische und psychiatrische Notfälle

Zusammenfassung

Bei der myasthenen Krise sind Plasmapherese und intravenöse Immunglobuline gleichwertig. Rituximab führt bei einer therapierefraktären Myasthenie häufig zu einer signifikanten Verbesserung. Bei der Behandlung des Guillain-Barré-Syndroms sind Plasmapherese und Immunglobuline gleichwertig. Kortikosteroide scheinen dagegen die Prognose zu verschlechtern. Durch die ausgedehnte Reisetätigkeit sind zunehmend “emerging viruses” wie West-Nil-Virus, Japan-Enzephalitisvirus oder Dengue-Virus als Ursache viraler Enzephalitiden zu beachten. Bei der transienten globalen Amnesie lassen sich in der dünnschichtigen MRT-Diffusionswichtung Störungen im CA1-Feld des Ammonshornes und mittels MR-Spektroskopie metabolische Änderungen in derselben Region nachweisen. In der Therapie der Subarachnoidalblutung waren große Studien zu intravenösem Magnesium und Clazosentan negativ. 2012 wurde die S3-Leitlinie zu Diagnostik und Therapie bipolarer Störungen veröffentlicht, die S3-Leitlinie zur Therapie schizophrener Störungen wird für dieses Jahr erwartet. Trazodon ist möglicherweise in der Therapie der Neuroleptika-induzierten Akathisie wirksam.

Summary

Recent trials showed no significant difference in efficacy between IVIG and plasmapheresis in the treatment of severe Myasthenia gravis. Rituximab is efficacious in refractory myasthenia. In case of GBS no significant superiority can be found for treatment with IVIG or plasmapheresis. Corticosteroids might delay recovery of patients with GBS. Due to extensive travel activity “emerging viruses” like West Nile virus, Japanese encephalitis virus or Dengue virus are increasingly frequent causes of viral encephalitis. In patients with TGA focal diffusion lesions can be selectively detected in the CA1 field of the hippocampal cornu ammonis by use of thin slice MRI. Magnetic resonance spectroscopy studies showed corresponding metabolic changes in CA 1 neurons. Recent large trials showed no benefit of Magnesium or Clazosentan in the management of subarachnoidal hemorrhage. In 2012 S3 guidelines for diagnosis and therapy of bipolar affective disorders were published, S3 guidelines for diagnosis and therapy of schizophrenic disorders are expected to be published this year. Trazodon might be effective in the management of neuroleptic-induced acute akathisia.

Schlüsselwörter

Notfall - Neurologie - Psychiatrie - Therapie

Keywords

Emergency - neurology - psychiatry - therapy

• Literatur

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