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Klinische Syndrome, Pathogenese und Differentialdiagnose

  • Herman-J. Gelmers
  • Günter Krämer
  • Werner Hacke
  • Michael Hennerici

Zusammenfassung

Die zeitlichen Aspekte einer zerebralen Ischämie und die dynamische Entwicklung neurologischer Ausfallserscheinungen sind wichtige Anhaltspunkte für die Analyse der zugrunde liegenden pathophysiologischen Mechanismen und bei der Suche nach einer hämodynamischen oder embolischen Ursache von großer Bedeutung. Die Krankheitssymptome selbst werden für die Lokalisation der ischämischen Hirnregion und zur Identifikation der betroffenen Gefäßterritorien herangezogen. Selbst bei typischen Krankheitsbildern ermöglichen die klinischen Daten allein oft keine eindeutige anatomische und pathogenetische Zuordnung, so wichtig sie für die Wahl der diagnostischen und therapeutischen Maßnahmen sein mögen: in den ersten Stunden nach einer zerebralen Ischämie ist auch die prognostische Beurteilung außerordentlich schwierig, und meist ist es unmöglich zu entscheiden, ob mit einer vollständigen Remission zu rechnen ist, oder ob sich unter einer progredienten Entwicklung ein schweres Defizit einstellt. Angesichts der aktuellen Überlegungen, ob thromboembolisch bedingte zerebrale Ischämien in der Akutphase ähnlich wie beim frischen Myokardinfarkt lysiert werden sollen (Zeumer 1985; del Zoppo et al. 1986; del Zoppo und Hacke 1987; Hacke et al. 1988), sind diese prognostischen Aspekte besonders wichtig, da nur solche Patienten dem mit der Behandlung verbundenen Blutungsrisiko ausgesetzt werden sollten, bei denen keine rasche Spontanremission erwartet wird.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • Herman-J. Gelmers
    • 1
  • Günter Krämer
    • 2
  • Werner Hacke
    • 3
  • Michael Hennerici
    • 4
  1. 1.Department of NeurologyStreekziekenhuisAlmeloNiederlande
  2. 2.Neurologische KlinikUniversitätskliniken MainzMainz 1Deutschland
  3. 3.Neurologische KlinikKlinikum der Universität HeidelbergHeidelberg 1Deutschland
  4. 4.Neurologische KlinikMed. Einrichtungen der Universität DüsseldorfDüsseldorf 1Deutschland

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