Zusammenfassung
Im Folgenden werden die wichtigsten neuen Erkenntnisse zur Prävention und Behandlung
des Schlaganfalls aus den Jahren 2003 und 2004 referiert. In der Primärprävention
zeigt sich, dass eine Östrogensubstitution nach der Menopause zu einem erhöhten Schlaganfallrisiko
führt. Die wichtigste präventive Maßnahme ist die Behandlung einer Hypertonie und
eine orale Antikoagulation bei Patienten mit Vorhofflimmern. Beim akuten Schlaganfall
hat sich in der Zwischenzeit die systemische und lokale Thrombolyse bei Patienten
die rechtzeitig auf eine Stroke Unit kommen etabliert. Randomisierte Studien zeigen,
dass intravenöses Magnesium beim akuten Schlaganfall nicht wirksam ist. In der Sekundärprävention
mit Thrombozytenfunktionshemmern wurden Untergruppen von Patienten identifiziert,
die von Clopidogrel mehr profitieren als von Azetylsalizylsäure. Die Wirkung von Dipyridamol
in der Schlaganfallprävention hat nichts mit der potenziell blutdrucksenkenden Wirkung
der Substanz zu tun. Für die vaskuläre Demenz sind Cholinesterasehemmer wie Donepezil
und wahrscheinlich auch Galantamin wirksam.
Abstract
This review reports new information about prevention and treatment of stroke gained
from publications in 2003 and 2004. Postmenopausal substitution of estrogen increases
stroke risk. The most effective treatment options in primary prevention are treatment
of high blood pressure in patients with hypertension and anticoagulation in patients
with atrial fibrillation. The only available treatment of acute ischemic stroke besides
stroke unit care is systemic and local thrombolysis in highly selected patients. Magnesium
i. v. is not effective. Most patients with TIA or ischemic stroke will be treated
with antiplatelet drugs for secondary prevention. Post-hoc analyses from the CAPRIE
trail identified subgroups of high risk patients who benefit from clopidogrel compared
to aspirin (diabetics, other major vascular events). The increased benefit of the
combination of aspirin plus dipyridamole is not due to any influence of dipyridamole
on blood pressure. Cholinesterase inhibitors are also effective in vascular dementia.
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Prof. Dr. Hans-Christoph Diener
Universitätsklinik für Neurologie · Universitätsklinikum Essen
Hufelandstraße 55
45122 Essen
Email: h.diener@uni-essen.de
