Skip to main content
main-content
Erschienen in: DGNeurologie 5/2022

09.08.2022 | Hirnblutung | CME Zertifizierte Fortbildung

Akutmanagement intrazerebraler Blutungen

verfasst von: A. Sekita, PD Dr. Joji B. Kuramatsu

Erschienen in: DGNeurologie | Ausgabe 5/2022

zum CME-Kurs Einloggen, um Zugang zu erhalten

Zusammenfassung

Die intrazerebrale Blutung (ICB) ist eine der schwerwiegendsten Formen des akuten Schlaganfalls. Im Gegensatz zum ischämischen Schlaganfall gibt es nur wenige effektive, nachweislich den klinischen Zustand nach ICB verbessernde Interventionen. Wichtigstes Ziel der Akuttherapie ist die Verhinderung eines Hämatomwachstums durch umgehende aggressive und kontrollierte systolische Blutdrucksenkung sowie sofortige Hämostase, meist sind zudem intensivmedizinische Maßnahmen indiziert. Chirurgische Strategien beinhalten oft eine externe Ventrikeldrainage bei okklusivem Hydrozephalus. Die Hämatomevakuation, dekompressive Verfahren oder minimalinvasive Ansätze stellen individuelle Therapieentscheidungen dar. Die intraventrikuläre Fibrinolyse und die überlappende Lumbaldrainage scheinen mit einem besseren funktionellen Zustand nach ICB assoziiert zu sein. Dennoch ist die ICB-Mortalität nach wie vor hoch, sodass eine präzise Prognoseabschätzung wichtig ist, um voreilige Therapieeinschränkungen zu vermeiden.
Literatur
1.
Zurück zum Zitat Qureshi AI, Mendelow AD, Hanley DF (2009) Intracerebral haemorrhage. Lancet 373(9675):1632–1644 CrossRef Qureshi AI, Mendelow AD, Hanley DF (2009) Intracerebral haemorrhage. Lancet 373(9675):1632–1644 CrossRef
2.
Zurück zum Zitat Schneider JA (2016) The cerebral cortex in cerebral amyloid angiopathy. Lancet Neurol 15(8):778–779 CrossRef Schneider JA (2016) The cerebral cortex in cerebral amyloid angiopathy. Lancet Neurol 15(8):778–779 CrossRef
3.
Zurück zum Zitat Krishnamurthi RV et al (2013) Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health 1(5):e259–e281 CrossRef Krishnamurthi RV et al (2013) Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health 1(5):e259–e281 CrossRef
4.
Zurück zum Zitat Kuramatsu JB et al (2017) Management von schwerwiegenden intrazerebralen Blutungen unter Antikoagulation. Akt Neurol 44:742–756 CrossRef Kuramatsu JB et al (2017) Management von schwerwiegenden intrazerebralen Blutungen unter Antikoagulation. Akt Neurol 44:742–756 CrossRef
5.
Zurück zum Zitat Cordonnier C et al (2018) Intracerebral haemorrhage: current approaches to acute management. Lancet 392(10154):1257–1268 CrossRef Cordonnier C et al (2018) Intracerebral haemorrhage: current approaches to acute management. Lancet 392(10154):1257–1268 CrossRef
6.
Zurück zum Zitat Demchuk AM et al (2012) Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): A prospective observational study. Lancet Neurol 11(4):307–314 CrossRef Demchuk AM et al (2012) Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): A prospective observational study. Lancet Neurol 11(4):307–314 CrossRef
7.
Zurück zum Zitat Morotti A et al (2020) Noncontrast CT markers of intracerebral hemorrhage expansion and poor outcome: A meta-analysis. Neurology 95(14):632–643 CrossRef Morotti A et al (2020) Noncontrast CT markers of intracerebral hemorrhage expansion and poor outcome: A meta-analysis. Neurology 95(14):632–643 CrossRef
8.
Zurück zum Zitat Al-Shahi Salman R et al (2018) Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data. Lancet Neurol 17(10):885–894 CrossRef Al-Shahi Salman R et al (2018) Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data. Lancet Neurol 17(10):885–894 CrossRef
10.
Zurück zum Zitat Moullaali TJ et al (2019) Blood pressure control and clinical outcomes in acute intracerebral haemorrhage: a preplanned pooled analysis of individual participant data. Lancet Neurol 18(9):857–864 CrossRef Moullaali TJ et al (2019) Blood pressure control and clinical outcomes in acute intracerebral haemorrhage: a preplanned pooled analysis of individual participant data. Lancet Neurol 18(9):857–864 CrossRef
11.
Zurück zum Zitat Li Q et al (2020) Ultra-early blood pressure reduction attenuates hematoma growth and improves outcome in Intracerebral hemorrhage. Ann Neurol 88(2):388–395 CrossRef Li Q et al (2020) Ultra-early blood pressure reduction attenuates hematoma growth and improves outcome in Intracerebral hemorrhage. Ann Neurol 88(2):388–395 CrossRef
12.
Zurück zum Zitat Steiner T et al (2016) Fresh frozen plasma versus prothrombin complex concentrate in patients with intracranial haemorrhage related to vitamin K antagonists (INCH): a randomised trial. Lancet Neurol 15(6):566–573 CrossRef Steiner T et al (2016) Fresh frozen plasma versus prothrombin complex concentrate in patients with intracranial haemorrhage related to vitamin K antagonists (INCH): a randomised trial. Lancet Neurol 15(6):566–573 CrossRef
13.
Zurück zum Zitat Goldstein JN et al (2015) Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial. Lancet 385(9982):2077–2087 CrossRef Goldstein JN et al (2015) Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial. Lancet 385(9982):2077–2087 CrossRef
14.
Zurück zum Zitat Kuramatsu JB et al (2015) Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. JAMA 313(8):824–836 CrossRef Kuramatsu JB et al (2015) Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. JAMA 313(8):824–836 CrossRef
15.
Zurück zum Zitat Gerner ST et al (2018) Association of prothrombin complex concentrate administration and hematoma enlargement in non-vitamin K antagonist oral anticoagulant-related intracerebral hemorrhage. Ann Neurol 83(1):186–196 CrossRef Gerner ST et al (2018) Association of prothrombin complex concentrate administration and hematoma enlargement in non-vitamin K antagonist oral anticoagulant-related intracerebral hemorrhage. Ann Neurol 83(1):186–196 CrossRef
16.
Zurück zum Zitat Inohara T et al (2018) Association of intracerebral hemorrhage among patients taking non-vitamin K antagonist vs vitamin K antagonist oral anticoagulants with in-hospital mortality. JAMA 319(5):463–473 CrossRef Inohara T et al (2018) Association of intracerebral hemorrhage among patients taking non-vitamin K antagonist vs vitamin K antagonist oral anticoagulants with in-hospital mortality. JAMA 319(5):463–473 CrossRef
17.
Zurück zum Zitat Connolly SJ et al (2019) Full study report of Andexanet alfa for bleeding associated with factor Xa inhibitors. N Engl J Med 380(14):1326–1335 CrossRef Connolly SJ et al (2019) Full study report of Andexanet alfa for bleeding associated with factor Xa inhibitors. N Engl J Med 380(14):1326–1335 CrossRef
18.
Zurück zum Zitat Huttner HB et al (2022) Hematoma expansion and clinical outcomes in patients with factor-Xa inhibitor-related atraumatic intracerebral hemorrhage treated within the ANNEXA-4 trial versus real-world usual care. Stroke 53(2):532–543 CrossRef Huttner HB et al (2022) Hematoma expansion and clinical outcomes in patients with factor-Xa inhibitor-related atraumatic intracerebral hemorrhage treated within the ANNEXA-4 trial versus real-world usual care. Stroke 53(2):532–543 CrossRef
19.
Zurück zum Zitat Sprigg N et al (2018) Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): An international randomised, placebo-controlled, phase 3 superiority trial. Lancet 391(10135):2107–2115 CrossRef Sprigg N et al (2018) Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): An international randomised, placebo-controlled, phase 3 superiority trial. Lancet 391(10135):2107–2115 CrossRef
21.
Zurück zum Zitat Staykov D, Schwab S (2013) Clearing bloody cerebrospinal fluid: clot lysis, neuroendoscopy and lumbar drainage. Curr Opin Crit Care 19(2):92–100 CrossRef Staykov D, Schwab S (2013) Clearing bloody cerebrospinal fluid: clot lysis, neuroendoscopy and lumbar drainage. Curr Opin Crit Care 19(2):92–100 CrossRef
22.
Zurück zum Zitat Staykov D et al (2017) Efficacy and safety of combined intraventricular fibrinolysis with lumbar drainage for prevention of permanent shunt dependency after intracerebral hemorrhage with severe ventricular involvement: A randomized trial and individual patient data meta-analysis. Ann Neurol 81(1):93–103 CrossRef Staykov D et al (2017) Efficacy and safety of combined intraventricular fibrinolysis with lumbar drainage for prevention of permanent shunt dependency after intracerebral hemorrhage with severe ventricular involvement: A randomized trial and individual patient data meta-analysis. Ann Neurol 81(1):93–103 CrossRef
23.
Zurück zum Zitat Mendelow AD et al (2005) 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 365(9457):387–397 CrossRef Mendelow AD et al (2005) 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 365(9457):387–397 CrossRef
24.
Zurück zum Zitat Mendelow AD et al (2013) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 382(9890):397–408 CrossRef Mendelow AD et al (2013) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 382(9890):397–408 CrossRef
25.
Zurück zum Zitat Hanley DF et al (2019) Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Lancet 393(10175):1021–1032 CrossRef Hanley DF et al (2019) Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Lancet 393(10175):1021–1032 CrossRef
26.
Zurück zum Zitat Sembill JA, Huttner HB, Kuramatsu JB (2018) Impact of recent studies for the treatment of Intracerebral hemorrhage. Curr Neurol Neurosci Rep 18(10):71 CrossRef Sembill JA, Huttner HB, Kuramatsu JB (2018) Impact of recent studies for the treatment of Intracerebral hemorrhage. Curr Neurol Neurosci Rep 18(10):71 CrossRef
27.
Zurück zum Zitat Kuramatsu JB et al (2019) Association of surgical hematoma evacuation vs conservative treatment with functional outcome in patients with cerebellar intracerebral hemorrhage. JAMA 322(14):1392–1403 CrossRef Kuramatsu JB et al (2019) Association of surgical hematoma evacuation vs conservative treatment with functional outcome in patients with cerebellar intracerebral hemorrhage. JAMA 322(14):1392–1403 CrossRef
28.
Zurück zum Zitat Zahuranec DB et al (2014) Intracerebral hemorrhage mortality is not changing despite declining incidence. Neurology 82(24):2180–2186 CrossRef Zahuranec DB et al (2014) Intracerebral hemorrhage mortality is not changing despite declining incidence. Neurology 82(24):2180–2186 CrossRef
29.
Zurück zum Zitat Geurts M et al (2014) End-of-life decisions in patients with severe acute brain injury. Lancet Neurol 13(5):515–524 CrossRef Geurts M et al (2014) End-of-life decisions in patients with severe acute brain injury. Lancet Neurol 13(5):515–524 CrossRef
30.
Zurück zum Zitat Sembill JA et al (2021) Multicenter validation of the max-ICH score in intracerebral hemorrhage. Ann Neurol 89(3):474–484 CrossRef Sembill JA et al (2021) Multicenter validation of the max-ICH score in intracerebral hemorrhage. Ann Neurol 89(3):474–484 CrossRef
31.
Zurück zum Zitat Sembill JA et al (2017) Severity assessment in maximally treated ICH patients: The max-ICH score. Neurology 89(5):423–431 CrossRef Sembill JA et al (2017) Severity assessment in maximally treated ICH patients: The max-ICH score. Neurology 89(5):423–431 CrossRef
32.
Zurück zum Zitat Suo Y et al (2018) The max-intracerebral hemorrhage score predicts long-term outcome of intracerebral hemorrhage. CNS Neurosci Ther 24(12):1149–1155 CrossRef Suo Y et al (2018) The max-intracerebral hemorrhage score predicts long-term outcome of intracerebral hemorrhage. CNS Neurosci Ther 24(12):1149–1155 CrossRef
Metadaten
Titel
Akutmanagement intrazerebraler Blutungen
verfasst von
A. Sekita
PD Dr. Joji B. Kuramatsu
Publikationsdatum
09.08.2022