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Schlaganfall und TIA

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Zuletzt revidiert von:

Definition:
Plötzlich einsetzender fokaler oder globaler Funktionsverlust aufgrund von Blutzirkulationsstörungen im Gehirn. Bei einer vollständigen Rückbildung der Symptome innerhalb von 24 Stunden spricht man von einer TIA (= transitorische ischämische Attacke). Gehirnblutungen (hämorrhagischer Insult) machen 10–15 %, Infarkte (ischämischer Insult) 80–85 % aus.
Häufigkeit:
Ca. 200.000 neue und insgesamt ca. 270.000 Schlaganfälle pro Jahr. Jährlich sterben ca. 63.000 Menschen an den Folgen eines Schlaganfalls. Der Schlaganfall ist somit die dritthäufigste Todesursache.
Symptome:
FAST: Am häufigsten sind Fazialisparese (Face), verringerte Kraft im Arm (Arm), Sprach-/Wortfindungsstörungen oder undeutliche Aussprache (Speech). Wenn diese Symptome vorliegen, dann umgehende Einweisung (Time)!
Befunde:
Paresen in den Extremitäten, Fazialisparese, Aphasie, evtl. Sensibilitätsstörungen, Sehstörungen, Bewusstseinsstörungen.
Diagnostik:
Akute Einweisung zur CT- oder MRT-Untersuchung.
Therapie:
Bei Infarkt: Thrombolyse innerhalb von 4,5 Stunden nach dem ersten Auftreten der Symptome, Behandlung auf der Schlaganfallsstation (Stroke Unit).
  • Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin. Schlaganfall. AWMF-Leitlinie Nr. 053-011. S3, Stand 2020. www.awmf.org 
  • Deutsche Gesellschaft für Allgemeinmedizin (DEGAM). Leitlinie: Hausärztliche Risikoberatung zur kardiovaskulären Prävention. S3, Stand 2017. www.degam.de 
  • Deutsche Gesellschaft für Neurologie. Diagnostik und Therapie von Gedächtnisstörungen. AWMF-Leitlinie Nr. 030-124. S2e, Stand 2020. www.awmf.org 
  • Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin: Neue Thrombozyten-Aggregationshemmer. Einsatz in der Hausarztpraxis. DEGAM-Leitlinie. AWMF-Leitlinie Nr. 053-041. S2e, Stand 2019. www.awmf.org 
  • Deutsche Gesellschaft für Neurologie, Deutsche Schlaganfall-Gesellschaft. Schlaganfall: Sekundärprophylaxe ischämischer Schlaganfall und transitorische ischämische Attacke. AWMF-Leitlinie Nr. 030-133. S3, Stand 2015. www.awmf.org 
  • Leitlinien zur Rehabilitation finden Sie im Artikel Rehabilitation nach einem Schlaganfall.
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  • Caroline Beier, Dr. med. Fachärztin für Allgemeinmedizin, Hamburg
  • Dirk Nonhoff, Dr. med., Facharzt für Allgemeinmedizin, Köln
  • Günther Egidi, Dr. med., Arzt für Allgemeinmedizin, Bremen (Review)

Frühere Autoren

  • Bent Indredavik, dr. med., seksjonsoverlege, seksjon for hjerneslag, Medisinsk avdeling, St. Olavs Hospital, Trondheim
  • Ingard Løge, spesialist i allmennmedisin, redaktør NEL