Skip to main content
SpringerLink
Log in

Schlaganfall

Stroke

  • Schwerpunkt: Neurologische Notfälle
  • Published:
Notfall & Rettungsmedizin Aims and scope Submit manuscript

Zusammenfassung

Der Schlaganfall ist mittlerweile eine behandelbare Erkrankung geworden. Pharmakologische Ansätze wie die Thrombolyse mit rt-PA, aber auch fundiertere Kenntnisse zu den erforderlichen Basismaßnahmen eröffnen insbesondere bei der Ischämie neue therapeutische Möglichkeiten. Aber das Zeitfenster ist eng, Transport in die Klinik und erste diagnostische Maßnahmen sollten spätestens 3 h nach Beginn der Symptomatik abgeschlossen sein: „time is brain!“ Doch nach wie vor geht zu viel Zeit verloren durch eine zu späte Verständigung des Rettungsdienstes oder durch unzureichende Logistik im Krankenhaus. Stroke Units sind in allen Bundesländern etabliert und haben sich auf die Behandlung des akuten Schlaganfall spezialisiert. Eine enge lokale und regionale Kooperation von Rettungsdiensten und Krankenhäusern sowie eine gute Aufklärungsarbeit der Bevölkerung sind erforderlich, um im Ernstfall einen reibungslosen und schnellen Ablauf zu gewährleisten.

Abstract

Stroke no longer is an untreatable disease. The introduction of special pharmacological therapeutic approaches, such as thrombolysis with rt-PA, and deeper knowledge of essential basic therapies to stabilize the patient open up new perspectives for stroke patients. However, the time window is narrow. Transport to hospital and first diagnostic tests such as CT scan and some blood tests should be completed with a maximum time frame of 3 hours: time is brain. Even nowadays valuable time is lost by delayed contact to the emergency dispatcher or by insufficient logistics in hospital. Stroke units have been established in all German states and are specialized to diagnose and treat acute stroke patients. A close local and regional cooperation between emergency personal and in-house hospital staff combined with an informed population are necessary to make a fast and professional care for stroke patients possible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Arboix A, Massons J, Oliveres M, Arribas MP, Titus F (1994) Headache in acute cerebrovascular disease: a prospective clinical study in 240 patients. Cephalalgia 14: 37–40

    Article  CAS  PubMed  Google Scholar 

  2. Burchfiel CM, Curb JD, Rodriguez BL, Abbott RD, Chiu D, Yano K (1994) Glucose intolerance and 22-year stroke incidence. The Honolulu Heart Program. Stroke 25: 951–957

    CAS  PubMed  Google Scholar 

  3. Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S (1999) Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA 282: 2019–2026

    Article  CAS  PubMed  Google Scholar 

  4. Collins R, MacMahon S (1994) Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease. Br Med Bull 50: 272–298

    CAS  PubMed  Google Scholar 

  5. Dandapani BK, Suzuki S, Kelley RE, Reyes-Iglesias Y, Duncan RC (1995) Relation between blood pressure and outcome in intracerebral hemorrhage. Stroke 26: 21–24

    CAS  PubMed  Google Scholar 

  6. Frank JI (1995) Large hemispheric infarction, deterioration, and intracranial pressure. Neurology 45: 1286–1290

    Google Scholar 

  7. Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R (1996) ‚Malignant‘ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 53: 309–315

    Google Scholar 

  8. Hacke W, Albers G, Al-Rawi Y et al.; DIAS Study Group (2005) The Desmoteplase in Acute Ischemic Stroke Trial (DIAS): a phase II MRI-based 9-hour window acute stroke thrombolysis trial withvintravenous desmoteplase. Stroke 36: 66–73

    Article  CAS  PubMed  Google Scholar 

  9. Holtkamp M, Buchheim K, Unterberg A, Hoffmann O, Schielke E, Weber JR, Masuhr F (2001) Hemicraniectomy in elderly patients with space occupying media infarction: improved survival but poor functional outcome. J Neurol Neurosurg Psychiatry 70: 226–228

    Google Scholar 

  10. Hutchinson PJ, Seeley HM, Kirkpatrick PJ (1998) Factors implicated in deaths from subarachnoid haemorrhage: are they avoidable? Br J Neurosurg 12: 37–40

    Google Scholar 

  11. Inao S, Kuchiwaki H, Wachi A, Andoh K, Nagasaka M, Sugita K, Furuse M (1990) Effect of mannitol on intracranial pressure-volume status and cerebral haemodynamics in brain oedema. Acta Neurochir Suppl (Wien) 51: 401–403

    Google Scholar 

  12. Kase C, Mohr JP, Caplan LR (1998) Intracerebral hemorrhage. In: Barnett HJM, Stein B, Yatsu F, Mohr JP (eds) Stroke: pathophysiology, diagnosis, and management. Churchill Livingstone, New York Philadelphia, pp 649–670

  13. Kolominsky-Rabas PL, Sarti C, Heuschmann PU et al. (1998) A prospective community-based study of stroke in Germany — the Erlangen Stroke Project (ESPro): incidence and case fatality at 1, 3, and 12 months. Stroke 29: 2501–2506

    PubMed  Google Scholar 

  14. Mayer SA, Brun NC, Broderick J, Davis S, Diringer MN, Skolnick BE, Steiner T (2005) Europe/AustralAsia NovoSeven ICH Trial Investigators. Safety and feasibility of recombinant factor VIIa for acute intracerebral hemorrhage. Stroke 36: 74–79

    Article  CAS  PubMed  Google Scholar 

  15. Mendelow AD, Gregson BA, Fernandes HM et al. (2005) STICH investigators. 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: 387–397

    PubMed  Google Scholar 

  16. Prospective studies collaboration (1995) Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Lancet 346: 1647–1653

    Article  PubMed  Google Scholar 

  17. Reith J, Jorgensen HS, Pedersen PM, Nakayama H, Raaschou HO, Jeppesen LL, Olsen TS (1996) Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome. Lancet 347: 422–425

    Article  CAS  PubMed  Google Scholar 

  18. Ropper AH, Shafran B (1984) Brain edema after stroke. Clinical syndrome and intracranial pressure. Arch Neurol 41: 26–29

    Google Scholar 

  19. Schwab S, Schwarz S, Aschoff A, Keller E, Hacke W (1998) Moderate hypothermia and brain temperature in patients with severe middle cerebral artery infarction. Acta Neurochir Suppl 71: 131–134

    CAS  PubMed  Google Scholar 

  20. Schrader J, Luders S, Kulschewski A et al.; Acute Candesartan Cilexetil Therapy in Stroke Survivors Study Group (2003) The ACCESS Study: evaluation of Acute Candesartan Cilexetil Therapy in Stroke Survivors. Stroke 34: 1699–1703

    Article  PubMed  Google Scholar 

  21. Schwab S, Steiner T, Aschoff A, Schwarz S, Steiner HH, Jansen O, Hacke W (1998) Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 29: 1888–1893

    CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  23. Trust Study Group (1990) Randomised, double-blind, placebo-controlled trial of nimodipine in acute stroke. Lancet 336: 1205–1209

    Article  PubMed  Google Scholar 

  24. Wannamethee SG, Shaper AG, Whincup PH, Walker M (1995) Smoking cessation and the risk of stroke in middle-aged men. JAMA 274: 155–160

    Article  CAS  PubMed  Google Scholar 

  25. Weimar C, Ziegler A, König IR, Diener HC (2002) Predicting functional outcome and survival after acute ischemic stroke. J Neurol 249: 888–895

    Article  PubMed  Google Scholar 

  26. Weir CJ, Murray GD, Dyker AG, Lees KR (1997) Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow up study. BMJ 314: 1303–1306

    CAS  PubMed  Google Scholar 

  27. Williams LS, Rotich J, Qi R et al. (2002) Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke. Neurology 59: 67–71

    Google Scholar 

Download references

Interessenkonflikt:

Keine Angaben

Author information

Authors and Affiliations

  1. Neurologische Klinik, Klinikum Idar-Oberstein und Neurologische Universitätsklinik Mainz

    M. Eicke

  2. Neurologische Klinik, Klinikum Idar-Oberstein GmbH und Neurologische Universitätsklinik Mainz, Langenbeckstr. 1, 55101, Mainz

    M. Eicke

Authors
  1. M. Eicke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Eicke.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Eicke, M. Schlaganfall. Notfall & Rettungsmedizin 8, 247–254 (2005). https://doi.org/10.1007/s10049-005-0736-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10049-005-0736-4

Schlüsselwörter

Keywords

Search

Navigation