Die aneurysmatische Subarachnoidalblutung

Die aneurysmatische Subarachnoidalblutung (SAB) ist eine relativ seltene Erkrankung, die im Vergleich zum ischämischen Schlaganfall deutlich jüngere Patienten betrifft. Auch hier gilt, dass eine suggestive klinische Symptomatik eine zügige Diagnostik nach sich ziehen sollte. Nach der Diagnose sollte die weitere Versorgung der Patienten mit SAB in einem spezialisierten Zentrum mit vorhandener Neurochirurgie und interventioneller Neuroradiologie erfolgen. Der Beitrag fasst das diagnostische und therapeutische Vorgehen sowie die Prognose und mögliche Komplikationen zusammen.

Schlüsselwörter

Intensivmedizin - Gehirnblutung - Schlaganfall - Aneurysma - Aneurysmaruptur

• Literatur

• 1 de Rooij NK, Linn FH, van der Plas JA. et al. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 2007; 78: 1365-1372
• 2 van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. Lancet 2007; 369: 306-318
• 3 Rinkel GJ, Algra A. Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage. Lancet Neurol 2011; 10: 349-356
• 4 Dodel R, Winter Y, Ringel F. et al. Cost of illness in subarachnoid hemorrhage: a German longitudinal study. Stroke 2010; 41: 2918-2923
• 5 Vlak MH, Algra A, Brandenburg R. et al. Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: a systematic review and meta-analysis. Lancet Neurol 2011; 10: 626-636
• 6 Giordan E, Graffeo CS, Rabinstein AA. et al. Aneurysmal subarachnoid hemorrhage: long-term trends in incidence and survival in Olmsted County, Minnesota. J Neurosurg 2020; 134: 878-883
• 7 Backes D, Rinkel GJ, Laban KG. et al. Patient- and aneurysm-specific risk factors for intracranial aneurysm growth: a systematic review and meta-analysis. Stroke 2016; 47: 951-957
• 8 Bakker MK, van der Spek RAA, van Rheenen W. et al. Genome-wide association study of intracranial aneurysms identifies 17 risk loci and genetic overlap with clinical risk factors. Nat Genet 2020; 52: 1303-1313
• 9 Bakker MK, Ruigrok YM. Genetics of intracranial aneurysms. Stroke 2021; 52: 3004-3012
• 10 Rinne J, Hernesniemi J, Puranen M. et al. Multiple intracranial aneurysms in a defined population: prospective angiographic and clinical study. Neurosurgery 1994; 35: 803-808
• 11 Hackenberg KAM, Hänggi D, Etminan N. Unruptured intracranial aneurysms. Stroke 2018; 49: 2268-2275
• 12 Rhoton jr. AL. Anatomy of saccular aneurysms. Surg Neurol 1980; 14: 59-66
• 13 Tada Y, Wada K, Shimada K. et al. Roles of hypertension in the rupture of intracranial aneurysms. Stroke 2014; 45: 579-586
• 14 Lovelock CE, Rinkel GJ, Rothwell PM. Time trends in outcome of subarachnoid hemorrhage: Population-based study and systematic review. Neurology 2010; 74: 1494-1501
• 15 Molyneux A, Kerr R, Stratton I. et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002; 360: 1267-1274
• 16 Ikawa F, Morita A, Tominari S. et al. Rupture risk of small unruptured cerebral aneurysms. J Neurosurg 2019;
• 17 Backes D, Vergouwen MD, Tiel Groenestege AT. et al. PHASES score for prediction of intracranial aneurysm growth. Stroke 2015; 46: 1221-1226
• 18 Molyneux AJ, Kerr RS, Yu LM. et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005; 366: 809-817
• 19 Butzkueven H, Evans AH, Pitman A. et al. Onset seizures independently predict poor outcome after subarachnoid hemorrhage. Neurology 2000; 55: 1315-1320
• 20 Lindbohm JV, Kaprio J, Jousilahti P. et al. Risk factors of sudden death from subarachnoid hemorrhage. Stroke 2017; 48: 2399-2404
• 21 McCarron MO, Alberts MJ, McCarron P. A systematic review of Terson’s syndrome: frequency and prognosis after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 2004; 75: 491-493
• 22 Hacein-Bey L, Provenzale JM. Current imaging assessment and treatment of intracranial aneurysms. AJR Am J Roentgenol 2011; 196: 32-44
• 23 Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med 2006; 354: 387-396
• 24 Claassen J, Bernardini GL, Kreiter K. et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke 2001; 32: 2012-2020
• 25 Frontera JA, Claassen J, Schmidt JM. et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery 2006; 59: 21-27
• 26 Boesiger BM, Shiber JR. Subarachnoid hemorrhage diagnosis by computed tomography and lumbar puncture: are fifth generation CT scanners better at identifying subarachnoid hemorrhage?. J Emerg Med 2005; 29: 23-27
• 27 Deutsche Gesellschaft für Neurologie. Leitlinie „Subarachnoidalblutung (SAB)“. AWMF-Registernummer: 030/073. 2015 Accessed March 21, 2022 at: https://www.awmf.org/leitlinien/detail/ll/030–073.html
• 28 Scaravilli V, Tinchero G, Citerio G. Fever management in SAH. Neurocrit Care 2011; 15: 287-294
• 29 Towner JE, Rahmani R, Zammit CG. et al. Mechanical ventilation in aneurysmal subarachnoid hemorrhage: systematic review and recommendations. Crit Care 2020; 24: 575
• 30 Chen S, Luo J, Reis C. et al. Hydrocephalus after subarachnoid hemorrhage: pathophysiology, diagnosis, and treatment. Biomed Res Int 2017; 2017: 8584753
• 31 Germanwala AV, Huang J, Tamargo RJ. Hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am 2010; 21: 263-270
• 32 Deutsche Gesellschaft für Neurologie. S1-Leitlinie „Intrakranieller Druck (ICP)“. AWMF-Registernummer: 030/105. 2018 Accessed March 21, 2022 at: https://www.awmf.org/leitlinien/detail/ll/030–105.html
• 33 Sterns RH, Silver SM. Cerebral salt wasting versus SIADH: what difference?. J Am Soc Nephrol 2008; 19: 194-196
• 34 Solenski NJ, Haley jr. EC, Kassell NF. et al. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. Crit Care Med 1995; 23: 1007-1017
• 35 Vergouwen MD, Vermeulen M, van Gijn J. et al. Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke 2010; 41: 2391-2395
• 36 Bartels E, Fuchs HH, Flügel KA. Color Doppler imaging of basal cerebral arteries: normal reference values and clinical applications. Angiology 1995; 46: 877-884
• 37 Mir DI, Gupta A, Dunning A. et al. CT perfusion for detection of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. AJNR Am J Neuroradiol 2014; 35: 866-871
• 38 Ramakrishna R, Stiefel M, Udoetuk J. et al. Brain oxygen tension and outcome in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 2008; 109: 1075-1082
• 39 Helbok R, Kofler M, Schiefecker AJ. et al. Clinical use of cerebral microdialysis in patients with aneurysmal subarachnoid hemorrhage-state of the art. Front Neurol 2017; 8: 565
• 40 Dorhout Mees SM, Rinkel GJ, Feigin VL. et al. Calcium antagonists for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2007; (03) CD000277
• 41 Soppi V, Karamanakos PN, Koivisto T. et al. A randomized outcome study of enteral versus intravenous nimodipine in 171 patients after acute aneurysmal subarachnoid hemorrhage. World Neurosurg 2012; 78: 101-109
• 42 Kronvall E, Undrén P, Romner B. et al. Nimodipine in aneurysmal subarachnoid hemorrhage: a randomized study of intravenous or peroral administration. J Neurosurg 2009; 110: 58-63
• 43 Connolly jr. ES, Rabinstein AA, Carhuapoma JR. et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke 2012; 43: 1711-1737
• 44 Gathier CS, van den Bergh WM, van der Jagt M. et al. Induced hypertension for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a randomized clinical trial. Stroke 2018; 49: 76-83
• 45 Treggiari MM. Hemodynamic management of subarachnoid hemorrhage. Neurocrit Care 2011; 15: 329-335