Ischämischer und hämorrhagischer Schlaganfall

Zusammenfassung

Schlaganfälle können entweder durch den Verschluss eines hirnversorgenden Gefäßes (ischämischer Schlaganfall) oder durch eine intrazerebrale Blutung (hämorrhagischer Schlaganfall) hervorgerufen werden. Zur Unterscheidung eines hämorrhagischen Schlaganfalls von einem ischämischen Schlaganfall ist eine Bildgebung mittels Computertomografie (CT) oder Magnetresonanztomografie (MRT) erforderlich. Die strikte Trennung von Ischämie und Hämorrhagierisiko wird der klinischen Problematik häufig nicht gerecht, da das gemeinsame Vorliegen von ischämischen (z. B. im Rahmen massiver mikroangiopathischer Läsionslast) und hämorrhagischen Ereignissen (ICBs, zerebrale Mikroblutungen) häufig ist. Eingriffe in die Blutgerinnung sind zur Therapie und Vorbeugung ischämischer Schlaganfälle sinnvoll und geboten, bei hämorrhagischen Ereignissen aber streng kontraindiziert. Daher ist im Vorfeld eine konsequente Abwägung des potentiellen Nutzens gegenüber möglichen Blutungskomplikationen unabdingbar.

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