Nichtmedikamentöse Prophylaxe des Schlaganfalls

 

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Zusammenfassung

Obwohl in den letzten Jahren wesentliche Fortschritte in der Akutbehandlung des Schlaganfalls zu verzeichnen sind (Thrombolyse, Behandlung auf der Stroke-Unit, optimierte Frührehabilitation), stellt der Schlaganfall nach wie vor die häufigste zu dauerhafter Behinderung führende Erkrankung dar. Von daher kommt einer Primärprävention und einer effektiven - an die Ätiopathogenese des Schlaganfalls angepassten - Sekundärprävention eine wesentliche Bedeutung zu. Neben medikamentösen Behandlungsoptionen (Antihypertensiva, Thrombozytenfunktionshemmer, Antikoagulation bei kardialer Emboliequelle, Statine etc.) gibt es auch zahlreiche und evidenzbasierte nichtmedikamentöse Maßnahmen zur Primär- und Sekundärprävention des Schlaganfalls. Im Folgenden wird der aktuelle Stand der nichtmedikamentösen Schlaganfallprophylaxe vorgestellt. Dabei wird zunächst auf den Stellenwert von Ernährung, Nikotinkonsum, Vitaminsubstitution, Behandlung der Hyperhomozysteinämie und körperlicher Aktivität für das Schlaganfallrisiko eingegangen. Im zweiten Teil werden Effektivität und Indikationen zur Sanierung einer symptomatischen bzw. asymptomatischen Karotisstenose dargestellt.

Abstract

Stroke is the leading cause of long-term major disability in developed countries, although several improvements could be achieved in acute stroke therapy (e. g. thrombolysis, stroke-unit treatment, optimized early rehabilitation strategies). Therefore, primary prevention as well as an effective secondary prevention- guided by the etiology and risk factors of the stroke - is of particular importance to reduce stroke morbidity. In addition to medical prevention strategies (antihypertensives, thrombocyte inhibitors, anticoagulation in atrial fibrillation, statins etc.) there are several and evidenced-based non-medical options for the primary and secondary prevention of stroke available. This review summarizes the actual status of non-medical prevention measures of stroke. In the first part we focused on the importance of nutrition, vitamin substitution, elevated homocysteine levels, and physical activity. In the second part we discussed the indications and efficiency of an invasive treatment of symptomatic and asymptomatic carotid stenosis.

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Prof. Dr. Dirk Sander

Neurologische Klinik der Technischen Universität München

Möhlstraße 28

81675 München

Email: Dirk.Sander@neuro.med.tu-muenchen.de