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Intrazerebrale Blutung: „hot topics“

Intracerebral hemorrhage: hot topics

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Zusammenfassung

In den vergangenen Jahren sind deutliche Fortschritte in der Akutbehandlung von Patienten mit intrazerebraler Blutung (ICB) erzielt worden. Zwar haben zahlreiche randomisierte Studien neutrale Ergebnisse geliefert, dennoch sind wichtige Erkenntnisse für das Design von Folgestudien generiert worden. Ferner ist eine Reihe an Observationsstudien veröffentlicht worden, welche die Basis für weitere methodisch stärkere Untersuchungen darstellen. Im Fokus steht die Vermeidung einer frühen Blutungsprogression, welche durch Blutdruckmanagement und Hämostase beeinflusst werden kann. Auch könnte die Operation der ICB durch minimal-invasive Techniken eine Renaissance erleben. Des Weiteren rückt das perifokale Ödem und dessen pharmakologische Modulation zunehmend in den Blickpunkt. Auch das Thema optimale Therapie des Ventrikeleinbruchs wird weiterhin sehr dynamisch weiterentwickelt. Schließlich sind in der langfristigen Therapie und der antithrombotischen Behandlung viele Entwicklungen angestoßen worden, die derzeit in randomisierten Studien untersucht werden. Der vorliegende Artikel geht auf diese relevantesten Themenkomplexe in der Akut- und Langzeittherapie von ICB-Patienten ein und gibt einen Überblick zu den aktuellen Kontroversen in diesen Behandlungsfeldern.

Abstract

Significant advances in the acute treatment of patients with intracerebral hemorrhage (ICH) have been achieved in recent years. While many randomized trials have provided neutral results, important findings have been generated for the design of follow-up studies. Furthermore, a number of observational studies have been published, which in turn provide the basis for further methodologically stronger investigations. The focus is on avoidance of early bleeding progression, which can be influenced by blood pressure management and hemostasis. Furthermore, ICH surgery may experience a renaissance through minimally invasive techniques. In addition, perihemorrhagic edema and its pharmacological modulation are becoming increasingly more important. Optimal treatment of ventricular involvement is continuing to develop dynamically. Finally, long-term antithrombotic treatment has been intensely studied in observational analyses and is currently being investigated in randomized trials. This article addresses these most relevant topics in acute and long-term treatment of ICH patients and provides an overview of current debates in these areas of treatment.

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Authors and Affiliations

  1. Neurologische Klinik, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland

    Maximilian I. Sprügel &  Hagen B. Huttner

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  1. Maximilian I. Sprügel
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  2. Hagen B. Huttner
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Correspondence to Hagen B. Huttner.

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Interessenkonflikt

M.I. Sprügel und H.B. Huttner geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Sprügel, M.I., Huttner, H.B. Intrazerebrale Blutung: „hot topics“. Nervenarzt 90, 987–994 (2019). https://doi.org/10.1007/s00115-019-0777-4

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