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Intensivmedizin up2date 2014; 10(02): 153-164
DOI: 10.1055/s-0034-1365344
Neuro-Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Intrazerebrale Blutung: Update zur Intensivtherapie

Rainer Kollmar
,
Andreas Unterberg
,
Thorsten Steiner
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Publication History

Publication Date:
01 April 2014 (online)

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Kernaussagen

  • Eine intrazerebrale Blutung (ICB) ist ein Notfall, der interdisziplinär behandelt werden sollte.

  • Die präklinische Versorgung unterscheidet sich nicht von der eines ischämischen Schlaganfalls.

  • Da eine ICB klinisch nicht von einer Ischämie zu unterscheiden ist, darf man in der präklinischen Phase unter keinen Umständen Antikoagulanzien verabreichen.

  • In der Klinik sollte man die Verdachtsdiagnose umgehend mit CT oder MRT bestätigen.

  • Eine aggressive Blutdrucksenkung auf systolische Werte unter 140 mmHg scheint sicher zu sein.

  • ICB haben eine hohe Nachblutungsrate, insbesondere innerhalb der ersten 4 Stunden, die im weiteren Verlauf abnimmt.

  • Die Gerinnung sollte man umgehend normalisieren, falls eine relevante Antikoagulation besteht.

  • Falls eine intraventrikuläre Blutung aufgetreten ist, sollte man die Anlage einer externen Ventrikeldrainage erwägen.

  • In aller Regel entwickelt sich ein perihämorrhagisches Ödem. Trotz fehlender Daten kann man dieses mit Osmotherapeutika behandeln. Eine experimentelle Alternative ist die milde Hypothermie.

  • Eine operative Hämatomentfernung kann nicht routinemäßig empfohlen werden. Sie bleibt bislang eine individuelle Entscheidung.

  • Zur Thromboseprophylaxe wird der Einsatz von niedermolekularem Heparin 24 Stunden nach ICB empfohlen, sofern eine Nachblutung im CT oder MRT ausgeschlossen ist.

 

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