Zusammenfassung
In den letzten Jahren haben sich Akuttherapie und Prävention des ischämischen Hirninfarktes
deutlich verbessert. Durch die Einrichtung von neurologischen Schlaganfallstationen,
die Zulassung der Thrombolyse und neuer Thrombozytenfunktionshemmer stehen differenzierte
Behandlungsstrategien zur Verfügung. Das multimodale Schlaganfall-MRT ist eine dem
kraniellen Computertomogramm (CCT) in der Akutphase überlegene Methode, mit der früh
die Pathogenese und die Prognose abgeschätzt werden können. Patienten mit perakuten
oder instabilen Hirninfarkten sollten auf einer Schlaganfallstation behandelt werden.
In den ersten drei Stunden nach Auftreten der Symptome ist die intravenöse Thrombolyse
mit t-PA eine sichere und effektive Therapie. Eine gesicherte Indikation für intravenöses
Heparin beim Schlaganfall gibt es nicht. Zur Prophylaxe können heute je nach individuellem
Risikoprofil verschiedene Thrombozytenfunktionshemmer neben der oralen Antikoagulation
eingesetzt werden. Patienten mit hochgradigen, symptomatischen Karotis-interna-Stenosen
sollten einer Thrombendarterektomie zugeführt werden, in Einzelfällen kann auch eine
Stent-Angioplastie indiziert sein. Die frühe osteoklastische Trepanation bei raumfordernden
Hirninfarkten ist eine lebensrettende und das klinische Endergebnis verbessernde Maßnahme.
Die zunehmend differenzierte Diagnostik und Therapie des ischämischen Hirninfarktes
erfordern auf der Basis der neurologischen Schlaganfallexpertise eine intensive interdisziplinäre
Zusammenarbeit.
Summary
Acute treatment and prevention of ischaemic stroke have improved significantly in
recent years. Stroke units, the approval of thrombolysis and new platelet inhibitors
offer innovative treatment strategies. The multimodal stroke MRI is superior to CCT
in predicting the pathogenesis and prognosis in the acute phase of stroke. Patients
with acute or unstable stroke should be treated on a stroke unit. Intravenous thrombolysis
with t-PA is safe and effective in the first three hours after onset of symptoms.
Intravenous heparin in stroke is not an evidence-based treatment. For stroke prevention,
various platelet inhibitors and oral anticoagulation can be used according to the
patients risk profile. Endarterectomy should be performed in patients with symptomatic,
severe stenosis of the internal carotid artery. In individual patients stent-angioplasty
can be considered. Early decompressive craniectomy can be life-saving and improves
the clinical outcome in space-occupying cerebral infarctions. The increasingly sophisticated
diagnostic and therapeutic possibilities in ischaemic stroke require intensive interdisciplinary
cooperation based on the neurological stroke expertise.
Key Words
stroke-unit - thrombolysis - stroke-prevention - diagnostic facilities
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1 national institut of neurological disorders and stroke
2 european cooperative acute stroke study
3 north american symptomatic carotid endarterectomy trial
4 european carotid surgery trial
5 stenting and angioplasty with protection in patients at high risk for endarterectomy
6 stentgeschützte perkutane Angioplastie der Karotis vs. Endarterektomie
Anschrift für die Verfasser
Dr. J. Philipps
Neurologische Klinik, Klinikum Minden
Friedrichstr. 17
32427 Minden
