Intrazerebrale Blutungen

1. Klassifikation

Intrazerebrale Blutungen (ICB) sind intraparenchymatöse Blutungen des Gehirns als Folge einer Störung der vaskulären Integrität zerebraler Gefäße. Entsprechend der Lokalisation können lobäre Blutungen (parietal, temporal, frontal, okzipital), Stammganglienblutungen (Putamen bzw. Nucl. lentiformis, Caudatum, Thalamus), Hirnstammblutungen (Pons, Mesenzephalon, Medulla oblongata) und zerebelläre Blutungen (Kleinhirnwurm, Kleinhirnhemisphäre) differenziert werden. Folgt man den Ursachen der Blutung, unterscheidet man primäre von sekundären, so genannten symptomatischen Blutungen. Primäre Blutungen sind hypertensiv oder durch eine zerebrale Amyloidangiopathie (CAA) bedingt. Ursachen für die im Vergleich selteneren symptomatischen ICB können z. B. Gerinnungsstörungen, ein Schädel-Hirn-Trauma oder eine Gefäßmalformation sein. Eine Auflistung verschiedener Ursachen sekundärer ICB zeigt [Tab. 1]. Besonders bei ventrikelnahen Blutungen kann es zum Einbruch der Blutung in das Ventrikelsystem kommen. Eine Sonderform stellt die sogenannte primäre intraventrikuläre Blutung dar, die ebenso wie die subarachnoidale Blutung gelegentlich parenchymatöse Blutungsanteile besitzen kann [1].

Tab. 1 Ursachen für sekundäre intrazerebrale Blutungen Trauma Neoplasma Arteriovenöse Malformation Kavernom Intrakranielles Aneurysma Venöses Angiom Gerinnungsstörung Durafistel Hämorrhagisch transformierter Hirninfarkt Vaskulitis Sinusvenenthrombose Drogenabusus (v. a. sympathomimetische Drogen)

Intrazerebrale Blutungen sind parenchymatöse Blutungen des Gehirns. Man unterscheidet primäre von sekundären (symptomatischen) ICB.

Literatur

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