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01.09.2007 | CME Weiterbildung • Zertifizierte Fortbildung

Aneurysmatische Subarachnoidalblutung

Bedeutung und Komplikationen

verfasst von: PD Dr. A.S. Sarrafzadeh, U. Kaisers, W. Boemke

Erschienen in: Die Anaesthesiologie | Ausgabe 9/2007

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Zusammenfassung

Die aneurysmatische Subarachnoidalblutung (SAB) ist mit einer Vielzahl neurologischer und extrakranieller Komplikationen assoziiert, die zu sekundären Hirnschäden führen können. Detektion und Vermeidung eines symptomatischen Vasospasmus und nachfolgender Hirninfarkte sind entscheidend für die weitere Prognose der Patienten. Als Neuromonitoring-Methoden zur Früherkennung einer Ischämie stehen u. a. die Messung des Hirngewebesauerstoffpartialdrucks und des Hirnstoffwechsels mittels Mikrodialyse zur Verfügung. Die Triple-H-Therapie (arterielle Hypertension, Hypervolämie und Hämodilution) ist die Behandlung der Wahl eines symptomatischen Vasospasmus und führt, wenn frühzeitig nach Auftreten eines vasospasmusbedingten ischämischen neurologischen Defizits begonnen, zu einer dauerhaften Rückbildung ischämischer Symptome. Weitere vielversprechende Therapieansätze sind die Gabe hoch selektiver ET_A-Rezeptor-Antagonisten und die intrazisternale Applikation von vasodilatierenden Pharmaka in Depotform. Künftige randomisierte multizentrische Studien werden zeigen, inwieweit die Methoden des modernen Neuromonitorings zu einer Verbesserung des intensivmedizinischen Managements und letztlich des „Outcome“ nach SAB beitragen können.

Alberti O, Becker R, Benes L et al. (2000) Initial hyperglycemia as an indicator of severity of the ictus in poor-grade patients with spontaneous subarachnoid hemorrhage. Clin Neurol Neurosurg 102: 78–83PubMedCrossRef

Allen GS, Ahn HS, Preziosi TJ et al. (1983) Cerebral arterial spasm: a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med 308: 619–624PubMedCrossRef

Awad IA, Carter LP, Spetzler RF et al. (1987) Clinical vasospasm after subarachnoid hemorrhage: response to hypervolemic hemodilution and arterial hypertension. Stroke 18: 365–372PubMed

Badjatia N, Topcuoglu MA, Buonanno FS et al. (2005) Relationship between hyperglycemia and symptomatic vasospasm after subarachnoid hemorrhage. Crit Care Med 33: 1603–1609; quiz 1623PubMedCrossRef

Bejjani GK, Bank WO, Olan WJ et al. (1998) The efficacy and safety of angioplasty for cerebral vasospasm after subarachnoid hemorrhage. Neurosurgery 42: 979–986; discussion 986–987PubMedCrossRef

Broderick JP, Brott T, Tomsick T et al. (1993) Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg 78: 188–191PubMed

Cesarini KG, Hardemark HG, Persson L (1999) Improved survival after aneurysmal subarachnoid hemorrhage: review of case management during a 12-year period. J Neurosurg 90: 664–672PubMedCrossRef

Connors AF Jr, Speroff T, Dawson NV et al.; SUPPORT Investigators (1996) The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA 276: 889–897PubMedCrossRef

Czosnyka M, Smielewski P, Czosnyka Z et al. (2003) Continuous assessment of cerebral autoregulation: clinical and laboratory experience. Acta Neurochir Suppl 86: 581–585PubMed

10.

Dehdashti AR, Rilliet B, Rufenacht DA et al. (2004) Shunt-dependent hydrocephalus after rupture of intracranial aneurysms: a prospective study of the influence of treatment modality. J Neurosurg 101: 402–407PubMedCrossRef

11.

Deibert E, Barzilai B, Braverman AC et al. (2003) Clinical significance of elevated troponin I levels in patients with nontraumatic subarachnoid hemorrhage. J Neurosurg 98: 741–746PubMed

12.

Diener HC, Putzki N, Berlit P (2005) Leitlinien für Diagnostik und Therapie in der Neurologie. Leitlinie Primär- und Sekundärprävention der zerebralen Ischämie. Thieme, Stuttgart

13.

Diringer MN, Wu KC, Verbalis JG et al. (1992) Hypervolemic therapy prevents volume contraction but not hyponatremia following subarachnoid hemorrhage. Ann Neurol 31: 543–550PubMedCrossRef

14.

Dorai Z, Hynan LS, Kopitnik TA et al. (2003) Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 52: 763–769; discussion 769–771PubMedCrossRef

15.

Drake C (1988) Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg 68: 985–986

16.

Drake CG (1981) Progress in cerebrovascular disease: management of cerebral aneurysm. Stroke 12: 273–283PubMed

17.

Dreier JP, Woitzik J, Fabricius M et al. (2006) Delayed ischaemic neurological deficits after subarachnoid haemorrhage are associated with clusters of spreading depolarizations. Brain 129: 3224–3237PubMedCrossRef

18.

Feigin VL, Rinkel GJ, Algra A et al. (1998) Calcium antagonists in patients with aneurysmal subarachnoid hemorrhage: a systematic review. Neurology 50: 876–883PubMed

19.

Findlay JM, Kassell NF, Weir BK et al. (1995) A randomized trial of intraoperative, intracisternal tissue plasminogen activator for the prevention of vasospasm. Neurosurgery 37: 168–176; discussion 177–178PubMedCrossRef

20.

Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6: 1–9PubMedCrossRef

21.

Friedman JA, Pichelmann MA, Piepgras DG et al. (2003) Pulmonary complications of aneurysmal subarachnoid hemorrhage. Neurosurgery 52: 1025–1031; discussion 1031–1032PubMedCrossRef

22.

Frontera JA, Fernandez A, Claassen J et al. (2006) Hyperglycemia after SAH: predictors, associated complications, and impact on outcome. Stroke 37: 199–203PubMedCrossRef

23.

Godje O, Hoke K, Lamm P et al. (1998) Continuous, less invasive, hemodynamic monitoring in intensive care after cardiac surgery. Thorac Cardiovasc Surg 46: 242–249PubMed

24.

Gruber A, Reinprecht A, Gorzer H et al. (1998) Pulmonary function and radiographic abnormalities related to neurological outcome after aneurysmal subarachnoid hemorrhage. J Neurosurg 88: 28–37PubMed

25.

Harrigan MR (1996) Cerebral salt wasting syndrome: a review. Neurosurgery 38: 152–160PubMedCrossRef

26.

Hart RG, Byer JA, Slaughter JR et al. (1981) Occurrence and implications of seizures in subarachnoid hemorrhage due to ruptured intracranial aneurysms. Neurosurgery 8: 417–421PubMedCrossRef

27.

Heros RC (1990) Intracranial aneurysms: a review. Minn Med 73: 27–32PubMed

28.

Heuer GG, Smith MJ, Elliott JP et al. (2004) Relationship between intracranial pressure and other clinical variables in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 101: 408–416PubMed

29.

Holloway KL, Barnes T, Choi S et al. (1996) Ventriculostomy infections: the effect of monitoring duration and catheter exchange in 584 patients. J Neurosurg 85: 419–424PubMedCrossRef

30.

Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14–20PubMed

31.

Jaeger M, Soehle M, Meixensberger J (2005) Brain tissue oxygen (PtiO2): a clinical comparison of two monitoring devices. Acta Neurochir Suppl 95: 79–81PubMed

32.

Jaeger M, Soehle M, Meixensberger J (2005) Improvement of brain tissue oxygen and intracranial pressure during and after surgical decompression for diffuse brain oedema and space occupying infarction. Acta Neurochir Suppl 95: 117–118PubMedCrossRef

33.

Kasuya H, Onda H, Takeshita M et al. (2002) Efficacy and safety of nicardipine prolonged-release implants for preventing vasospasm in humans. Stroke 33: 1011–1015PubMedCrossRef

34.

Kerner A, Schlenk F, Sakowitz OW et al. (2007) Hyperglycemia: impact on neurological deficits and extracellular glucose levels in aneurysmal subarachnoid hemorrhage (SAH) patients. Neurol Res (in press)

35.

Klimo P Jr, Kestle JR, MacDonald JD et al. (2004) Marked reduction of cerebral vasospasm with lumbar drainage of cerebrospinal fluid after subarachnoid hemorrhage. J Neurosurg 100: 215–224PubMed

36.

Klimo P Jr, Thompson CJ, Drake J et al. (2004) Assessing the validity of the endoscopic shunt insertion trial: did surgical experience affect the results? J Neurosurg 101: 130–133PubMed

37.

Kroll M, Juhler M, Lindholm J (1992) Hyponatraemia in acute brain disease. J Intern Med 232: 291–297PubMedCrossRef

38.

Lanzino G, Kassell NF (1999) Double-blind, randomized, vehicle-controlled study of high-dose tirilazad mesylate in women with aneurysmal subarachnoid hemorrhage. Part II. A cooperative study in North America. J Neurosurg 90: 1018–1024PubMed

39.

Lanzino G, Kassell NF, Germanson T et al. (1993) Plasma glucose levels and outcome after aneurysmal subarachnoid hemorrhage. J Neurosurg 79: 885–891PubMed

40.

Mack WJ, King RG, Ducruet AF et al. (2003) Intracranial pressure following aneurysmal subarachnoid hemorrhage: monitoring practices and outcome data. Neurosurg Focus 14: e3PubMed

41.

Manninen PH, Ayra B, Gelb AW et al. (1995) Association between electrocardiographic abnormalities and intracranial blood in patients following acute subarachnoid hemorrhage. J Neurosurg Anesthesiol 7: 12–16PubMedCrossRef

42.

Mayhall CG, Archer NH, Lamb VA et al. (1984) Ventriculostomy-related infections: a prospective epidemiologic study. N Engl J Med 310: 553–559PubMedCrossRef

43.

McGirt MJ, Blessing R, Nimjee SM et al. (2004) Correlation of serum brain natriuretic peptide with hyponatremia and delayed ischemic neurological deficits after subarachnoid hemorrhage. Neurosurgery 54: 1369–1373; discussion 1373–1374PubMedCrossRef

44.

Meixensberger J, Vath A, Jaeger M et al. (2003) Monitoring of brain tissue oxygenation following severe subarachnoid hemorrhage. Neurol Res 25: 445–450PubMedCrossRef

45.

Muench E, Horn P, Bauhuf C et al. (2007) Effects of hypervolemia and hypertension on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation after subarachnoid hemorrhage. Crit Care Med (in press)

46.

Münch E, Horn P, Vajkoczy P (2006) Management des Patienten mit Subarachnodalblutung. In: Kuhlen R, Putensen C, Quintel M (Hrsg) Jahrbuch Intensivmedizin 2006. Medizinisch-wissenschaftlische Verlagsgesellschaft, Berlin, S 109–121

47.

Munch E, Vajkoczy P (2006) Current advances in the diagnosis of vasospasm. Neurol Res 28: 703–712PubMedCrossRef

48.

Ohkuma H, Fujita S, Suzuki S (2002) Incidence of aneurysmal subarachnoid hemorrhage in Shimokita, Japan, from 1989 to 1998. Stroke 33: 195–199PubMedCrossRef

49.

Ohkuma H, Tabata H, Suzuki S et al. (2003) Risk factors for aneurysmal subarachnoid hemorrhage in Aomori, Japan. Stroke 34: 96–100PubMedCrossRef

50.

Raabe A, Beck J, Berkefeld J et al. (2005) [Recommendations for the management of patients with aneurysmal subarachnoid hemorrhage]. Zentralbl Neurochir 66: 79–91PubMedCrossRef

51.

Robertson CS, Gopinath SP, Goodman JC et al. (1995) SjvO2 monitoring in head-injured patients. J Neurotrauma 12: 891–896PubMed

52.

Rosenorn J, Eskesen V, Schmidt K et al. (1987) The risk of rebleeding from ruptured intracranial aneurysms. J Neurosurg 67: 329–332PubMed

53.

Rosenwasser RH, Armonda RA, Thomas JE et al. (1999) Therapeutic modalities for the management of cerebral vasospasm: timing of endovascular options. Neurosurgery 44: 975–979; discussion 979–980PubMedCrossRef

54.

Ross D, Rosegay H, Pons V (1988) Differentiation of aseptic and bacterial meningitis in postoperative neurosurgical patients. J Neurosurg 69: 669–674PubMedCrossRef

55.

Sakr YL, Lim N, Amaral AC et al. (2004) Relation of ECG changes to neurological outcome in patients with aneurysmal subarachnoid hemorrhage. Int J Cardiol 96: 369–373PubMedCrossRef

56.

Sarrafzadeh A, Haux D, Kuchler I et al. (2004) Poor-grade aneurysmal subarachnoid hemorrhage: relationship of cerebral metabolism to outcome. J Neurosurg 100: 400–406PubMed

57.

Sarrafzadeh A, Haux D, Plotkin M et al. (2005) Bedside microdialysis reflects dysfunction of cerebral energy metabolism in patients with aneurysmal subarachnoid hemorrhage as confirmed by 15 O-H2 O-PET and 18 F-FDG-PET. J Neuroradiol 32: 348–351PubMed

58.

Sarrafzadeh A, Haux D, Sakowitz O et al. (2003) Acute focal neurological deficits in aneurysmal subarachnoid hemorrhage: relation of clinical course, CT findings, and metabolite abnormalities monitored with bedside microdialysis. Stroke 34: 1382–1388PubMedCrossRef

59.

Schade RP, Schinkel J, Roelandse FW et al. (2006) Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis. J Neurosurg 104: 101–108PubMed

60.

Schade RP, Schinkel J, Visser LG et al. (2005) Bacterial meningitis caused by the use of ventricular or lumbar cerebrospinal fluid catheters. J Neurosurg 102: 229–234PubMedCrossRef

61.

Schuiling WJ, Algra A, Weerd AW de et al. (2006) ECG abnormalities in predicting secondary cerebral ischemia after subarachnoid haemorrhage. Acta Neurochir 148: 853–858; discussion 858CrossRef

62.

Schuiling WJ, Dennesen PJ, Tans JT et al. (2005) Troponin I in predicting cardiac or pulmonary complications and outcome in subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 76: 1565–1569PubMedCrossRef

63.

Solenski NJ, Haley EC Jr, Kassell NF et al. (1995) Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. Crit Care Med 23: 1007–1017PubMedCrossRef

64.

Steudle L, Radke J, Clausen T (2006) Perioperatives Management von Patienten mit aneurysmatischer Subarachnoidalblutung. Anästh Intensivmed 47: 530–552

65.

Strong AJ, Hartings JA, Dreier JP (2007) Cortical spreading depression: an adverse but treatable factor in intensive care? Curr Opin Crit Care 13: 126–133PubMedCrossRef

66.

Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness: a practical scale. Lancet 2: 81–84PubMedCrossRef

67.

Unterberg AW, Sakowitz OW, Sarrafzadeh AS et al. (2001) Role of bedside microdialysis in the diagnosis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg 94: 740–749PubMed

68.

Vajkoczy P, Horn P, Thome C et al. (2003) Regional cerebral blood flow monitoring in the diagnosis of delayed ischemia following aneurysmal subarachnoid hemorrhage. J Neurosurg 98: 1227–1234PubMedCrossRef

69.

Vajkoczy P, Meyer B, Weidauer S et al. (2005) Clazosentan (AXV-034343), a selective endothelin A receptor antagonist, in the prevention of cerebral vasospasm following severe aneurysmal subarachnoid hemorrhage: results of a randomized, double-blind, placebo-controlled, multicenter phase IIa study. J Neurosurg 103: 9–17PubMed

70.

Bergh WM van den, Zuur JK, Kamerling NA et al. (2002) Role of magnesium in the reduction of ischemic depolarization and lesion volume after experimental subarachnoid hemorrhage. J Neurosurg 97: 416–422PubMedCrossRef

71.

Varelas P, Helms A, Sinson G et al. (2006) Clipping or coiling of ruptured cerebral aneurysms and shunt-dependent hydrocephalus. Neurocrit Care 4: 223–228PubMedCrossRef

72.

Veyna RS, Seyfried D, Burke DG et al. (2002) Magnesium sulfate therapy after aneurysmal subarachnoid hemorrhage. J Neurosurg 96: 510–514PubMedCrossRef

73.

Holst H von, Mathiesen T (1990) Electrolyte concentrations in serum and CSF following subarachnoid haemorrhage. Br J Neurosurg 4: 123–126

74.

Wijdicks EF, Vermeulen M, Murray GD et al. (1990) The effects of treating hypertension following aneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg 92: 111–117PubMedCrossRef

75.

Yanagihara T, Piepgras D, Atkinson J (1998) Subarachnoid hemorrhage: an overview. In: Yanagihara T, Piepgras D, Atkinson J (Eds) Subarachnoid hemorrhage. Medical and surgical management. Marcel Dekker Inc., New York, p 4 & 86

76.

Yundt KD, Grubb RL Jr, Diringer MN et al. (1998) Autoregulatory vasodilation of parenchymal vessels is impaired during cerebral vasospasm. J Cereb Blood Flow Metab 18: 419–424PubMedCrossRef

Titel: Aneurysmatische Subarachnoidalblutung
Bedeutung und Komplikationen
verfasst von: PD Dr. A.S. Sarrafzadeh
U. Kaisers
W. Boemke
Publikationsdatum: 01.09.2007
Verlag: Springer-Verlag
Erschienen in: Die Anaesthesiologie / Ausgabe 9/2007
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-007-1244-3

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