Akutversorgung des isch?mischen Schlaganfalls

New diagnostic and therapeutic developments have led to an innovative approach to stroke therapy. The slogan “time is brain” emphasizes that stroke is a medical emergency comparable to myocardial infarction. The stroke unit conception is an evidence based therapy for all stroke patients and improves outcome significantly. The monitoring of vitals signs and the management of stroke specific complications are highly effective. Early secondary prophylaxis reduces the risk of recurrence. The effect of CT based thrombolysis within the time window of 4,5 h has been substantiated by current data. Stroke MRI holds the promise for an improved therapy by patient stratification and by opening the time window. Interventional recanalisation, vascular interventions and hemicraniectomy complement the therapeutic options in the acute phase of stroke.     

Akutversorgung des isch?mischen Schlaganfalls

The management of acute ischemic stroke aims to verify the clinical diagnosis, to start general supportive care and to enable decision-making about specific forms of therapy. The risk-benefit ratio is time-dependent for many therapeutic options; therefore time delays are a disadvantage within the rescue chain. The trained and multidisciplinary team of the stroke unit forms the backbone of acute management. In addition, technical infrastructure influences therapeutic options and cerebral imaging is the cornerstone. The following four therapies are evidence-based: treatment on a stroke unit, thrombolysis, early administration of acetylsalicylic acid (ASS) and hemicraniectomy in patients younger than 60 years with a so-called malignant infarction. This article describes the necessary diagnostic steps and the general and specific therapeutic options that comprise acute management within the first 48?h.     

Glyk?miekontrolle in der Akutphase des isch?mischen Schlaganfalls

The acute phase of ischemic stroke is associated with hyperglycaemia in about 80% of diabetics and 30% of non-diabetics, which can lead to poorer prognosis in the case of extensive brain infarction. This “post-stroke hyperglycaemia” (PSH) is associated with a two- to fourfold greater risk of a poor functional outome and mortality. The pathophysiology of PSH is characterized as a neuroendocrine “stress reaction”; however, the mechanisms of damage are not yet fully understood. A number of studies demonstrated the feasibility of tight glycaemic control; however, such a strategy carries the risk of hypoglycaemia. The GIST-UK intervention study of 2007 could not demonstrate a beneficial effect of reduced blood glucose levels on clinical endpoints. However, this study should not be misinterpreted as a “laissez-faire” signal in relation to necessary strict glycaemic control. The results of the 2009 GLIAS study suggest an optimal target for blood glucose levels at between 7 and 8.6 mmol/l.     

Pr?vention des Schlaganfalls

On the background of aging population an increase of patients suffering from stroke has to be expected during the next years and decades. Strokes are the 3rd leading cause of death and reason for disability in Germany and many other countries. An effective treatment of the modifiable risk factors hypertension, hyperlipidemia, diabetes mellitus, atrial fibrillation, smoking, alcohol consumption, and adipositas is of enormous impact. Due to the linear relationship between blood pressure and risk of stroke, the treatment of hypertension is the most important and effective one in primary as well as in secondary prevention. Treatment with platelet inhibitors plays an additional important role in secondary prevention. Patients with atrial fibrillation should receive an effective oral anticoagulatory therapy when there are certain risk factors.     

Primär- und Sekundärprävention des Schlaganfalls bei Diabetes

Stroke is one of the most important causes of permanent disability and death in adults worldwide. In addition to hypertension, smoking, lack of physical activity and cardiac diseases, diabetes mellitus is an independent and modifiable risk factor for ischemic stroke. To date no unambiguous evidence exists for a reduction of the incidence of stroke by normalizing and lowering of long-term glucose levels with or without drugs. Nevertheless, normalization of blood glucose is an important goal in daily clinical practice. This also applies to the acute phase after stroke. Excessive lowering of short-term and long-term glucose levels is not recommended due to the increased risk of adverse events (hypoglycemia) which outweighs possible benefits. The focus in the prevention of stroke in patients with diabetes consists of guideline-conform treatment of modifiable vascular risk factors, such as hypertension, hyperlipoproteinemia, obesity and smoking.     

Empfehlungen der Europäischen Schlaganfall-Initiative zur Versorgung und Behandlung des Schlaganfalls

Zusammenfassung Dieser Artikel fasst die Empfehlungen zur Behandlung des Schlaganfalls der Europ?ischen Schlaganfall-Initiative (EUSI) für das Europ?ische Schlaganfall-Council (ESC), die Europ?ische Neurologische Gesellschaft (ENS) und die Europ?ische F?rderation Neurologischer Gesellschaften (EFNS) zusammen.      

Pathophysiologie und Prävention des Typ-2-Diabetes

Die Diabetologie - In den letzten beiden Jahren wurden neue Erkenntnisse zur Pathophysiologie und Prävention des Typ-2-Diabetes im Rahmen des Diabetes Updates präsentiert, die in...     

Sekundärprophylaxe des Schlaganfalls aus neurologischer Perspektive

Patients who have suffered ischemic stroke or transient ischemic attack (TIA) are at high risk of recurrent stroke, myocardial infarction or vascular death. Early pathophysiological based diagnostics and resulting secondary prevention are critical for reduction of stroke risk. Optimization of lifestyle factors, treatment of hypertension, cholesterol reduction with statins and use of antiplatelet agents in non-cardiogenic or anticoagulation in cardiogenic ischemia as well as internal carotid revascularization, in cases of more than 50% diameter stenosis of the internal carotid artery, are proven strategies for reduction of ischemic stroke risk.     

Prä- und peripartale Übertragung des Hepatitis C-Virus

Ohne Zusammenfassung     

Sekund?rprophylaxe des Schlaganfalls nach PRoFESS und SPARCL

Stroke is still the leading cause of long-term major disability in developed countries, although several improvements have been achieved in acute stroke therapy (e.g. thrombolysis, stroke-unit treatment,etc.). Therefore, an effective secondary prevention – guided by the etiology and risk factors of stroke – is of particular importance to reduce stroke morbidity. Recently, two important studies (SPARCL and PRoFESS) analyzed the significance of statin therapy as well as the efficacy of different antiplatelet therapies for secondary stroke prevention. In this review we summarize the results and discuss the implications of these findings – including the most recent data – for stroke prevention.     

Prävention des Diabetes

The aims of diabetes prevention are reduction of visceral obesity at the physiological level, the implementation of prevention managers at the structural level and realization of measures for primary prevention of diabetes in the daily routine at the conceptual level. The IMAGE toolkit for diabetes prevention is one of the products of a European study group of the IMAGE project. It is based on IMAGE evidence-based guidelines and the IMAGE training curriculum for prevention managers. It includes practical examples and worksheets which substantially facilitate the implementation of a prevention program and can be directly transferred from the toolkit. After a European curriculum for prevention managers was developed within the framework of the IMAGE project, it could be implemented in Germany over the previous 2 years and intensively evaluated. Since the beginning of 2013 a German curriculum for the further training to prevention manager is available and can currently be appreciated in Dresden. Various healthcare insurances rely on this model and intend to increase the use of preventive measures by the linking of prevention and healthcare treatment. The check-up 35+ can be such a measure. This article reports on these and other elements of prevention.     

Die Auswirkung des milden kontinuierlichen. Traumatismus und das Problem des Präcarcinoms

Ohne ZusammenfassungMikrobiologische Abteilung. Beauftragter: Prof.Francesco Domenico Rezzesi.Mit 18 Textabbildungen.Meiner Meinung nach sind präcarcinomatöse Zustände, wie ich diese auffasse, für die Krebsforschung von sehr großer Bedeutung. Deelmann (Das Präcarciniom 1929).