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„Delayed cerebral ischemia“ nach aneurysmatischer Subarachnoidalblutung

Prävention, Diagnostik und Therapie

Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Prevention, diagnostics and therapy

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Zusammenfassung

Eine verzögert eintretende zerebrale Ischämie („delayed cerebral ischemia“, DCI) ist neben der Schwere der initialen Blutung der wesentliche prognostische Faktor für das Behandlungsergebnis nach aneurysmatischer Subarachnoidalblutung. Im Gegensatz zur Massivität der initialen Blutung sind Auftreten und Folgen einer DCI sowohl einer prophylaktischen als auch therapeutischen Intervention zugänglich. Der bisherige Ansatz, statt der Ischämie den angiographischen Vasospasmus in den Vordergrund der Behandlung zu stellen, hat sich nicht als erfolgreich erwiesen.

Der Beitrag beschreibt DCI-Prävention sowie Monitoring- und Therapiekonzepte für Patienten mit aneurysmatischer Subarachnoidalblutung im Hinblick auf ihre Wirksamkeit auf die verzögerte zerebrale Ischämie und den gegenwärtigen Wissensstand.

Summary

Delayed cerebral ischemia (DCI) is the second most important impacting factor for functional outcome after aneurysmal subarachnoid hemorrhage (SAH) following the initial severity of the bleeding. In contrast to the initial SAH severity the presence and consequences of DCI can be managed with prophylactic and therapeutic interventions. The previous notion of treatment of angiographically observed vasospasm has not been shown to be successful.

This article covers prevention, monitoring and therapeutic concepts for patients with SAH with emphasis on the efficacy for DCI and current and ongoing research projects.

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Authors and Affiliations

  1. Klinik für Neurochirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow, Berlin, Deutschland

    S. Wolf

  2. Klinik für Neurologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland

    K.E. Wartenberg

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  1. S. Wolf
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Correspondence to K.E. Wartenberg.

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Wolf, S., Wartenberg, K. „Delayed cerebral ischemia“ nach aneurysmatischer Subarachnoidalblutung. Nervenarzt 83, 1542–1550 (2012). https://doi.org/10.1007/s00115-012-3528-3

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  • DOI: https://doi.org/10.1007/s00115-012-3528-3

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