Download PDF
Aktuelle Neurologie 2006; 33(5): 251-256
DOI: 10.1055/s-2005-915315
Neues in der Neurologie
© Georg Thieme Verlag KG Stuttgart · New York

Intrazerebrale Blutung - Was gibt es Neues?

Spontaneous Intracerebral Haemorrhages - What is New?T.  Steiner1 , H.-C.  Diener1 , A.  Unterberg2 , W.  Hacke3
  • 1Neurologische Klinik, Universität Heidelberg
  • 2Neurochirurgische Klinik, Universität Heidelberg
  • 3Neurologische Klinik, Universität Duisburg-Essen
Further Information

Publication History

Publication Date:
02 May 2006 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Anfang 2005 wurden zwei multizentrische, randomisierte und kontrollierte Studien zur Therapie der spontanen intrazerebralen Blutung (ICB) veröffentlicht: Der International Surgical Trial in Intracerebral Haemorrhage (STICH) befasste sich mit dem Effekt einer frühen operativen Behandlung, die zweite Studie mit der Wirkung von aktiviertem rekombinantem Faktor VII bei ICBs. Wir fassen hier die wesentlichen Untersuchungsergebnisse dieser beiden Studien zusammen und diskutieren die Konsequenzen für die zukünftige Therapie und weitere klinische Studien. Dabei berücksichtigen wir gegenwärtige pathophysiologische Konzepte und Ergebnisse anderer Studien zur Behandlung der spontanen ICB.

Abstract

Two multicentre, randomized, controlled trials for the therapy of spontaneous intracerebral hemorrhage (ICH) were published at the beginning of 2005. The International Surgical Trial in Intracerebral Haemorrhage (STICH) investigated the effectiveness of early surgical intervention. The second trial investigated the effectiveness of activated recombinant factor VII (rFVIIa) to prevent rebleeding in acute ICH. The results of these trials are summarized. We discuss the consequences of the trials for future treatment and clinical trials in reflection of current pathophysiological concepts and other trials in ICH.

Literatur

  • 1 Weimar C, Weber C, Wagner M. et al . Management patterns and health care use after intracerebral hemorrhage. A cost-of-illness study from a societal perspective in Germany.  Cerebrovasc Dis. 2003;  15 29-36
    PubMedGoogle Scholar
  • 2 Broderick J, Brott T, Duldner J E. et al . Volume of intracrerbral hemorrhage: a powerful and easy-to-use predictor of 30-day mortality.  Stroke. 1993;  24 987-993
    CrossrefPubMedGoogle Scholar
  • 3 Fujii Y, Tanaka R, Takeuchi S. et al . Hematoma enlargement in spontaneous intracerebral hemorrhage.  J Neurosurg. 1994;  80 51-57
    PubMedGoogle Scholar
  • 4 Fujitsu K, Muramoto M, Ikeda Y. et al . Indications for surgical treatment of putaminal hemorrhage. Comparative study based on serial CT and time-course analysis.  J Neurosurg. 1990;  73 518-525
    CrossrefPubMedGoogle Scholar
  • 5 Kazui S, Naritomi H, Yamamoto H. et al . Enlargement of spontaneous intracerebral hemorrhage. Incidence and time course.  Stroke. 1996;  27 1783-1787
    CrossrefPubMedGoogle Scholar
  • 6 Brott T, Broderick J, Kothari R. et al . Early hemorrhage growth in patients with intracerebral hemorrhage.  Stroke. 1997;  28 1-5
    CrossrefPubMedGoogle Scholar
  • 7 Gebel Jr J M, Jauch E C, Brott T G. et al . Natural History of Perihematomal Edema in Patients With Hyperacute Spontaneous Intracerebral Hemorrhage.  Stroke. 2002;  33 2631-2635
    CrossrefPubMedGoogle Scholar
  • 8 Lee K R, Kawai N, Kim S. et al . Mechanisms of edema formation after intracerebral hemorrhage: effects of thrombin on cerebral blood flow, blood-brain barrier permeability, and cell survival in a rat model.  J Neurosurg. 1997;  86 272-278
    CrossrefPubMedGoogle Scholar
  • 9 Butcher K S, Baird T, MacGregor L. et al . Perihematomal edema in primary intracerebral hemorrhage is plasma derived.  Stroke. 2004;  35 1879-1885
    CrossrefPubMedGoogle Scholar
  • 10 Xi G. Intracerebral hemorrhage: pathophysiology and therapy.  Neurocritical Care. 2004;  1 5-18
    CrossrefPubMedGoogle Scholar
  • 11 Ropper A. Lateral displacement of the brain and level of consciousness in patients with acute hemispherical mass.  New England Journal of Medicine. 1986;  314 953-958
    PubMedGoogle Scholar
  • 12 Qureshi A I, Tuhrim S, Broderick J P. et al . Spontaneous intracerebral hemorrhage.  N Engl J Med. 2001;  344 1450-1460
    CrossrefPubMedGoogle Scholar
  • 13 Tuhrim S, Horowitz D R, Sacher M. et al . Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage.  Crit Care Med. 1999;  27 617-621
    CrossrefPubMedGoogle Scholar
  • 14 Diringer M N, Edwards D F, Zazulia A R. Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage.  Stroke. 1998;  29 1352-1357
    CrossrefPubMedGoogle Scholar
  • 15 Konsensusgruppe Intrazerebrale Blutungen .Intrazerebrale Blutung. Leitlinien der Deutschen Gesellschaft für Neurologie (DGN). 2004; 2005
    Google Scholar
  • 16 Schwarz S, Schmiedek P. Zerebrale Blutungen - Chirurgische Behandlung. In: Diener H-C, Hacke W, Forsting M (Hrsg) Referenzreihe Neurologie, Schlaganfall. Stuttgart; Georg Thieme Verlag 2003: 107-112
    Google Scholar
  • 17 Mendelow A D, Gregson B A, Fernandes H M. et al . Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial.  Lancet. 2005;  9457 387-397
    PubMedGoogle Scholar
  • 18 Shaw M D, Mendelow A D, Teasdale G M. et al . Alterations to STICH protocol.  Lancet. 2003;  362 1244
    PubMedGoogle Scholar
  • 19 Mendelow A D. More conclusions from the International Surgical Trial in Intracerebral Haemorrhage (STICH). European Stroke Conference (ESC). Bologna; Virtual Stroke University 27.5.2005 http://stroke-university.com/view
    Google Scholar
  • 20 Morgenstern L B, Frankowski R F, Shedden P. et al . Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial.  Neurology. 1998;  51 1359-1363
    PubMedGoogle Scholar
  • 21 Morgenstern L B, Demchuk A M, Kim D H. et al . Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage.  Neurology. 2001;  56 1294-1299
    CrossrefPubMedGoogle Scholar
  • 22 Prasad K, Shrivastava A. Surgery for primary supratentorial intracerebral haemorrhage. Cochrane Database Syst Rev 2000 CD000200
    Google Scholar
  • 23 Fernandez L, Norwood S, Roettger R. et al . Bedside percutaneous tracheostomy with bronchoscopic guidance in critically ill patients.  Archives of Surgery. 1996;  131 129-132
    PubMedGoogle Scholar
  • 24 Roos Y B, Rinkel G J, Vermeulen M. et al .Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2003 CD001245
    Google Scholar
  • 25 Kassell N F, Haley E C, Torner J C. Antifibrinolytic therapy in the treatment of aneurysmal subarachnoid hemorrhage.  Clin Neurosurg. 1986;  33 137-145
    PubMedGoogle Scholar
  • 26 Roos Y. Antifibrinolytic treatment in subarachnoid hemorrhage: a randomized placebo-controlled trial. STAR Study Group.  Neurology. 2000;  54 77-82
    CrossrefPubMedGoogle Scholar
  • 27 Adams Jr H P, Nibbelink D W, Torner J C. et al . Antifibrinolytic therapy in patients with aneurysmal subarachnoid hemorrhage. A report of the cooperative aneurysm study.  Arch Neurol. 1981;  38 25-29
    PubMedGoogle Scholar
  • 28 Vujkovac B, Sabovic M. Treatment of subdural and intracerebral haematomas in a haemodialysis patient with tranexamic acid.  Nephrol Dial Transplant. 2000;  15 107-109
    CrossrefPubMedGoogle Scholar
  • 29 Piriyawat P, Morgenstern L B, Yawn D. et al . Treatment of acute intracerebral hemorrhage with e-aminocaproic acid - a pilot study.  Neurocritical Care. 2004;  1 47-51
    CrossrefPubMedGoogle Scholar
  • 30 Hoffman M, Monroe 3rd D M. A cell-based model of hemostasis.  Thromb Haemost. 2001;  85 958-965
    PubMedGoogle Scholar
  • 31 Hoffmann M, Monroe D M, Roberts H R. Activated factor VII activates factors IX and X on the surface of activated platelets: thoughts on the mechanism of action of high-dose activated VII.  Blood Coagul Fibrinolysis. 1998;  9 S61-S65
    PubMedGoogle Scholar
  • 32 Mayer S, Brun N, Broderick J. et al . Safety and feasibility of recombinant factor VIIa for acute intracerebral hemorrhage.  Stroke. 2005;  36 74-79
    CrossrefPubMedGoogle Scholar
  • 33 Steiner T, Seremetis S, Skolnick B E. et al . Safety of recombinant coagulation factor VII in patients with acute intracerebral hemorrhage.  Cerebrovasc Dis. 2004;  17 67
    PubMedGoogle Scholar
  • 34 Mayer S, Brun N, Broderick J. et al . Recombinant activated factor VII for acute intracerebral hemorrhage.  N Engl J Med. 2005;  352 777-785
    CrossrefPubMedGoogle Scholar
  • 35 Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials.  Arch Intern Med. 1994;  154 1449-1457
    CrossrefPubMedGoogle Scholar
  • 36 Go A S, Hylek E M, Phillips K A. et al . Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.  JAMA. 2001;  285 2370-2375
    CrossrefPubMedGoogle Scholar
  • 37 Rosand J, Eckman M H, Knudsen K A. et al . The effect of warfarin and intensity of anticoagulation on outcome of intracerebral hemorrhage.  Arch Intern Med. 2004;  164 880-884
    CrossrefPubMedGoogle Scholar
  • 38 Yasaka M, Minematsu K, Naritomi H. et al . Predisposing factors for enlargement of intracerebral hemorrhage in patients treated with warfarin.  Thromb Haemost. 2003;  89 278-283
    PubMedGoogle Scholar
  • 39 Flibotte J J, Hagan N, O'Donnell J. et al . Warfarin, hematoma expansion, and outcome of intracerebral hemorrhage.  Neurology. 2004;  63 1059-1064
    CrossrefPubMedGoogle Scholar
  • 40 Steiner T, Diringer M, Rosand J. Intracerebral hemorrhage associated with oral anticoagulant therapy: current practices and open questions.  Stroke. 2006;  37 256-262
    CrossrefPubMedGoogle Scholar
  • 41 Erhardtsen E, Nony P, Dechavanne M. et al . The effect of recombinant factor VIIa (NovoSeven) in healthy volunteers receiving acenocoumarol to an International Normalized Ration above 2.0.  Blood Coagul Fibrinolysis. 1998;  9 741-748
    CrossrefPubMedGoogle Scholar
  • 42 Park P, Fewel M E, Thompson B G. et al . Recombinant activated factor VII for the rapid correction of coagulopathy in nonhemophilic neurosurgical patients.  Neurosurgery. 2003;  53 34-38; discussion 38 - 39
    CrossrefPubMedGoogle Scholar
  • 43 Freeman W D, Brott T G, Barrett K M. et al . Recombinant factor VIIa for rapid reversal of warfarin anticoagulation in acute intracranial hemorrhage.  Mayo Clin Proc. 2004;  79 1495-1500
    CrossrefPubMedGoogle Scholar
  • 44 NINDS ICH Workshop Participants . Priorities for Clinical Research in Intracerebral Hemorrhage. Report From a National Institute of Neurologic Disorders and Stroke Workshop.  Stroke. 2005;  36 e23-e41
    CrossrefPubMedGoogle Scholar

Prof. Dr. Thorsten Steiner

Neurologische Klinik · Universität Heidelberg

Im Neuenheimer Feld 400

69120 Heidelberg

Email: thorsten_steiner@med.uni-heidelberg.de

      >