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Zerebrale Ischämie

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Neurologische Intensivmedizin

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Zusammenfassung

Der ischämische zerebrale Insult, die mit 70% häufigste Ursache eines Schlaganfalls, wird durch eine fokale Durchblutungsstörung im Versorgungsgebiet einer Hirnarterie ausgelöst. Die Zahl der jährlichen Neuerkrankungen am Hirninfarkt (Inzidenz) liegt um 130 pro 100.000 Personen, wobei eine starke Altersabhängigkeit zu berücksichtigen ist (Brown 1996). Die Frühleta-lität wird mit 10-30% innerhalb des 1. Monats nach Insult angegeben, danach beträgt die Sterblichkeit pro Jahr 9%. Etwa 30% der Patienten bleiben dauerhaft behindert und auf Pflege angewiesen, nur ein Drittel der Patienten erreicht wieder die volle berufliche und soziale Rehabilitation. Dies hat erhebliche sozioökonomische Auswirkungen, nach amerikanischen Berechnungen ist im Durchschnitt mit ca. 90.000 US-$ Folgekosten pro Schlaganfallpatient zu rechnen (Taylor 1996).

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Literatur

  • Adams HP, Bendixen BH, Kappelle LJ et al. (1993) Classification of subtype of acute ischemic stroke. Stroke 24:35–41.

    Article  PubMed  Google Scholar 

  • Adams HP, Brott TG, Furian AJ et al. (1996) Guidelines for thrombolytic therapy for acute stroke: A supplement to the guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Circulation 94:1167–1174.

    Article  PubMed  Google Scholar 

  • Aichner FT, Fazekas F, Brainin M, Pölz W, Mamoli B, Zeiler K (1998) Hypervolemic hemo-dilution in acute ischemic stroke. Stroke 29:743–49.

    Article  CAS  PubMed  Google Scholar 

  • Baron JC, Kummer R von, Zoppo GJ del (1995) Treatment of acute stroke. Challenging the concept of a rigid and universal time window. Stroke 26:2219–221.

    Article  CAS  PubMed  Google Scholar 

  • Barsan WG, Brott TG, Broderick JP et al. (1994) Urgent therapy for acute stroke. Effects of a stroke trial on untreated patients. Stroke 25:2132–2137.

    Article  CAS  PubMed  Google Scholar 

  • Bassetti C, Bogousslavsky J (1996) Klinische Symptome und Syndrome des Hirnschlags. Therapeutische Umschau 53:519–527.

    CAS  PubMed  Google Scholar 

  • Becker K, Purcell L, Hacke W, Hanley D (1996) Vertebrobasilar thrombosis: diagnosis, management, and the use of intra-arterial thrombolytics. Crit Care Med 24:1729–1742.

    Article  CAS  PubMed  Google Scholar 

  • Berlit P (1997) Klassifikation zerebraler Ischämien. Nervenheilkunde 16:468–471.

    Google Scholar 

  • Bettmann MA, Katzen BT, Whisnant J et al. (1998) Carotid stenting and angioplasty. Stroke 29:336–338.

    Article  CAS  PubMed  Google Scholar 

  • Bozzao L, Fantozzi LM, Bastianello S et al. (1989) Early collateral blood supply and late par-enchymal brain damage in patients with middle cerebral artery occlusion. Stroke 20:735–740.

    Article  CAS  PubMed  Google Scholar 

  • Brandt T, Kummer R von, Müller-Küppers M, Hacke W (1996) Thrombolytic therapy of acute basilar artery occlusion. Stroke 27:875–881.

    Article  CAS  PubMed  Google Scholar 

  • Broderick J, Brott T, Haley EC et al. (1993) Blood pressure during the first minutes of focal brain ischemia. Ann Emerg Med 22:1438–1443.

    Article  CAS  PubMed  Google Scholar 

  • Brown RD, Whisnant JP, Sicks JRD et al. (1996) Stroke incidence, prevalence and survival. Secular trends in Rochester, Minnesota, through 1989. Stroke 27:373–380.

    CAS  PubMed  Google Scholar 

  • Busse O (1997) Intensivstation — Stroke Unit — Rehabilitationsklinik. Nervenheilkunde 16: 488–494.

    Google Scholar 

  • CAST Collaborative Group (1997) CAST: randomized placebo-controlled trial of early aspirin use in 20000 patients with acute ischemic stroke. Lancet 349:1641–1649.

    Article  Google Scholar 

  • Clifton GL, Allen S, Barrodale P et al. (1993) A Phase II study of moderate hypothermia in severe brain injury. J Neurotrauma 10:263–271.

    Article  CAS  PubMed  Google Scholar 

  • Daffertshofer M, Ries S, Schminke U, Hennerici M (1996) High-intensity transient signals in patients with cerebral ischemia. Stroke 27:1844–1849.

    Article  CAS  PubMed  Google Scholar 

  • Donnan GA, Davis SM, Chambers BR et al. (1995) Trials of streptokinase in severe acute ischemic stroke. Lancet 345:578–579.

    Article  CAS  PubMed  Google Scholar 

  • Dornan WA, Stroink AR, Pegg EE, Kattner AA, Gupta K (1998) Community stroke awareness program increases public knowledge of stroke. Stroke 29:288.

    Google Scholar 

  • Ginsberg MD, Busto R (1998) Combating hyperthermia in acute stroke. Stroke 29:529–534.

    Article  CAS  PubMed  Google Scholar 

  • Ginsberg MD, Sternau LL Globus MYT, Dietrich WD, Busto R (1992) Therapeutic modulation of brain temperature: Relevance to ischemic brain injury. Cerebrovasc Brain Metab Rev/Vol 4:189–225.

    CAS  Google Scholar 

  • Grond M, Kummer R von, Sobesky J et al. (1997a) Early computed-tomography abnormalities in acute stroke. Lancet 350:1595–1596.

    Article  CAS  PubMed  Google Scholar 

  • Grond M, Rudolf J, Neveling M et al. (1997b) Risk of immediate héparine after rt-PA therapy in acute ischemic stroke. Cerebrovasc Dis 7:318–323.

    Article  Google Scholar 

  • Grond M, Rudolf J, Schmülling S et al. (1998b) Early intravenous thrombolysis with recombinant tissue-type plasminogen activator in vertebrobasilar ischemic stroke. Arch Neurol 55:466–469.

    Article  CAS  PubMed  Google Scholar 

  • Grond M, Stenzel Ch, Schmülling S et al. (1998 a) Early intravenous thrombolysis in a community-based approach. Stroke — in press.

    Google Scholar 

  • Hacke W (1997) Intensive care in acute stroke. Cerebrovasc Dis 7 [Suppl 3]:18–23.

    Article  Google Scholar 

  • Hacke W, for the European Ad Hoc Consensus Group (1996) European strategies for early intervention in stroke. Cerebrovasc Dis 6:315–324.

    Article  Google Scholar 

  • Hacke W, for the European Ad Hoc Consensus Group (1998) Neuroprotection as initial therapy in acute stroke. Cerebrovasc Dis 8:59–72.

    Article  Google Scholar 

  • Hacke W, Kaste M, Fieschi C et al, for the ECASS Study Group (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. JAMA 274:1017–1025.

    Article  CAS  PubMed  Google Scholar 

  • Hacke W, Schwab S, Horn M et al. (1996) Malignant middle cerebral artery territory infarction. Arch Neurol 53:309–315.

    Article  CAS  PubMed  Google Scholar 

  • Hacke W, Zeumer H, Ferbert A et al. (1988) Intra-arterial thrombolytic therapy improves outcome in ptients with acute vertebrobasilar occlusive disease. Stroke 19:1216–1222.

    Article  CAS  PubMed  Google Scholar 

  • Hamann GF (1997) Der akute Hirninfarkt: Pathophysiologie und moderne Therapiekonzepte. Radiologe 37:843–852.

    Article  CAS  PubMed  Google Scholar 

  • Heiss WD, Graf R (1997) Therapeutic window in ischaemic stroke. Experimental concepts, neuroimaging studies and implications for pharmacological treatment. CNS Drugs 8:474–491.

    Article  Google Scholar 

  • Horner S, Ni XS, Weihs W et al. (1997) Simultaneous bilateral contrast transcranial doppler monitoring in patients with intracardiac and intrapulmonary shunts. J Neurol Sci 150: 49–57.

    Article  CAS  PubMed  Google Scholar 

  • Hunter GJ, Hamberg LM, Ponzo JA et al. (1998) Assessment of cerebral perfusion and arterial anatomy in hyperacute stroke with three-dimensional functional CT: early clinical results. Am J Neuroradiol 19:29–37.

    CAS  PubMed  Google Scholar 

  • International Stroke Trial Collaborative Group (1997) The International Stroke Trial (1ST): a randomized trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischemic stroke. Lancet 349:1569–1581.

    Article  Google Scholar 

  • Jorgensen HS, Nakayama H, Raaschou HO et al. (1995) The effect of a stroke unit: Reduction in mortality, discharge rate to nursing home, length of hospital stay, and cost. Stroke 26:1178–1182.

    Article  CAS  PubMed  Google Scholar 

  • Kay R, Wong KS, Yu YL (1995) Low-molecular-weight heparin for the treatment of acute ischemic stroke. N Engl J Med 333:1588–1593.

    Article  CAS  PubMed  Google Scholar 

  • Kummer R von, Allen KL, Holle R et al. (1997) Acute stroke: Usefulness of early CT findings before thrombolytic therapy. Radiology 205:327–333.

    Article  Google Scholar 

  • Kummer R von, Meyding-Lamadé U, Forsting M et al. (1994) Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk. Am J Neuroradiol 15:9–15.

    Google Scholar 

  • Lisk DR, Grotta JC, Lamki LM et al. (1993) Should hypertension be treated after acute stroke? Arch Neurol 50:855–862.

    Article  CAS  PubMed  Google Scholar 

  • Lutsep HL, Albers GW, DeCrespigny A et al. (1997) Clinical utility of diffusion-weighted magnetic resonance imaging in the assessment of ischemic stroke. Ann Neurol 41:574–580.

    Article  CAS  PubMed  Google Scholar 

  • Marion DW, Obrist WD, Carlier PM et al. (1993) The use of moderate therapeutic hypothermia for patients with severe head injuries: a preliminary report. J Neurosurg 79:354–362.

    Article  CAS  PubMed  Google Scholar 

  • Marion DW, Penrod LE, Kelsey SF et al. (1997) Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med 336:540–546.

    Article  CAS  PubMed  Google Scholar 

  • Mori E (1991) Fibrinolytic recanalization therapy in acute cerebrovascular thromboembo-lism. In: Hacke W, Zoppo GJ del, Hirschberg M (eds) Thrombolytic therapy in acute ischemic stroke. Springer, Berlin Heidelberg New York Tokio, pp 137–146.

    Chapter  Google Scholar 

  • Miiffelmann B, Glahn J, Kunz St, Busse O (1995) Strategien zur frühen Aufnahme von Schlaganfallpatienten. Nervenarzt 66:111–115.

    Google Scholar 

  • Multicenter Acute Stroke Trial — Europe Study Group (1996) Thrombolytic therapy with streptokinase in acute ischemic stroke. N Engl J Med 335:145–150.

    Article  Google Scholar 

  • Multicenter Acute Stroke Trial — Italy (MAST-I) Group (1995) Randomized controlled trail of streptokinase, aspirin, and combination of both in treatment of acute ischemic stroke. Lancet 346:1509–1514.

    Article  Google Scholar 

  • National Institute of Neurological Disorders and Stroke r-tPA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587.

    Article  Google Scholar 

  • NINDS rt-PA Stroke Study Group (1997) Generalized efficacy of t-PA for acute stroke: subgroup analysis of the NINDS t-PA Stroke Trial. Stroke 28:2119–2125.

    Article  Google Scholar 

  • Pulsinelli W (1992) Pathophysiology of acute ischemic stroke. Lancet 339:533–536.

    Article  CAS  PubMed  Google Scholar 

  • Reith J, Jorgensen HS, Pedersen PM et al. (1996) Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome. Lancet 347:422–425.

    Article  CAS  PubMed  Google Scholar 

  • Ringelstein EB, Kommission „Stroke Units“ der Deutschen Gesellschaft für Neurologie (1998) Empfehlung für die Einrichtung von Schlaganfallspezialstationen („Stroke Units“). Nervenarzt 69:180–185.

    Article  CAS  PubMed  Google Scholar 

  • Schriger DL, Kalafut M, Starkman S, Krueger M, Saver JL (1998) Cranial computed tomography interpretation in acute stroke. JAMA 279:1293–1297.

    Article  CAS  PubMed  Google Scholar 

  • Schwab S, Aschoff A, Spranger M, Albert F, Hacke W (1996) The value of intracranial pressure monitoring in acute hemispheric stroke. Neurology 47:393–398.

    Article  CAS  PubMed  Google Scholar 

  • Schwab S, Schwarz S, Spranger M, Keller E, Bertram M, Hacke W (1998 b) Moderate hypothermia in the treatment of patients with severe MCA infarction. Stroke — in press.

    Google Scholar 

  • Schwab S, Spranger M, Aschoff A, Steiner T, Hacke W (1997) Brain temperature monitoring and modulation in patients with severe MCA infarction. Neurology 48:762–767.

    Article  CAS  PubMed  Google Scholar 

  • Schwab S, Steiner T, Aschoff A et al. (1998 a) Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke — in press.

    Google Scholar 

  • Shiozaki T, Sugimoto H, Taneda M et al. (1993) Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury. J Neurosurg 79:363–368.

    Article  CAS  PubMed  Google Scholar 

  • Steiner T, Mendoza G, DeGeorgia M et al. (1997) Prognosis of stroke patients requiring mechanical ventilation in a neurological critical care unit. Stroke 28:711–715.

    Article  CAS  PubMed  Google Scholar 

  • Sturzenegger M (1991) Ultrasound findings in spontaneous carotid artery dissection. The value of duplex sonography. Arch Neurol 41:1057–1063.

    Article  Google Scholar 

  • Taylor TN, Davis PH, Torner JC et al. (1996) Lifetime cost of stroke in the United States. Stroke 27:1459–1466.

    Article  CAS  PubMed  Google Scholar 

  • Theron J, Courtheoux P, Casasco A et al. (1989) Local intrarterial fibrinolysis in the carotid territory. Am J Neuroradiol 10:753–765.

    CAS  PubMed  Google Scholar 

  • TOAST Investigators (1998) Low-molecular-weight heparinoid Org 10172 (Danaparoid), and outcome after acute stroke. JAMA 279:1265–1272.

    Article  Google Scholar 

  • Weir CJ, Murray GD, Dyker AG, Lees KR (1997) Is hyperglycaemia an indépendant predictor of poor outcome after stroke? Br Med J 314:1303–1306.

    Article  CAS  Google Scholar 

  • Wildermuth S, Knauth M, Brandt T et al. (1998) Role of CT angiography in patient selection for thrombolytic therapy in acute hemispheric stroke. Stroke 29:935–938.

    Article  CAS  PubMed  Google Scholar 

  • Zeumer H, Freitag HJ, Zanella F, Arning C (1993) Local intra-arterial fibrinolytic therapy in patients with stroke: urokinase vs. recombinant tissue plasminogenactivator (rt-PA). Neuroradiaology 35:159–162.

    Article  CAS  Google Scholar 

  • Zoppo GJ del, Ferbert A, Otis S et al. (1988) Local intra-arterial fibrinolytic therapy in acute carotid territory stroke. A pilot study. Stroke 19:307–313.

    Article  PubMed  Google Scholar 

  • Zoppo GJ del, Schmid-Schönbein GW, Mori E et al. (1991) Polymorphonuclear leucocytes occlude capillaries following middle cerebral artery occlusion and reperfusion in baboons. Stroke 22:1276–1283.

    Article  PubMed  Google Scholar 

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Authors
  1. M. Grond
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  2. D. Krieger
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  3. O. Busse
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  4. W. Hacke
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Editor information

Editors and Affiliations

  1. Neurologische Klinik, Universitätsklinikum, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    Stefan Schwab  & Werner Hacke  & 

  2. Department of Neurology, Cleveland Clinic Foundation, 9500 Euclid/Ave, Cleveland, OH, 44195-5061, USA

    Derk Krieger

  3. Neurologische Klinik, Universität Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland

    Wolfgang Müllges

  4. Neurologische Klinik, Universität München, Marchioninistraße 15, 81377, München, Deutschland

    Gerhard Hamann

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© 1999 Springer-Verlag Berlin Heidelberg

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Grond, M., Krieger, D., Busse, O., Hacke, W. (1999). Zerebrale Ischämie. In: Schwab, S., Krieger, D., Müllges, W., Hamann, G., Hacke, W. (eds) Neurologische Intensivmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-58415-2_16

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  • DOI: https://doi.org/10.1007/978-3-642-58415-2_16

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  • Print ISBN: 978-3-642-63583-0

  • Online ISBN: 978-3-642-58415-2

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