Zusammenfassung
Klinisches/methodisches Problem
Klinisch imponieren Kleinhirnsyndrome durch Ataxie, Dysarthrie, Dysmetrie, Intentionstremor und Augenbewegungsstörungen.
Radiologische Standardverfahren
Neben der Anamnese und klinischen Untersuchung ist die Bildgebung v. a. wichtig um andere Erkrankungen wie Hydrozephalus und Multiinfarktdemenz von degenerativen Kleinhirnerkrankungen zu differenzieren. Zu den degenerativen Erkrankungen mit Kleinhirnbeteiligung gehören der Morbus Parkinson, die Multisystematrophie sowie weitere Erkrankungen einschließlich der spinozerebellären Ataxien.
Bewertung
Neben der MRT sind auch nuklearmedizinische Untersuchungen zur Differenzierung hilfreich.
Empfehlung für die Praxis
Axiale Fluid-attenuated-inversion-recovery(FLAIR)- und T2-gewichtete Sequenzen können mitunter eine Signalsteigerung im Pons als Ausdruck einer Degeneration der pontinen Neuronen und transversalen Bahnen im Brückenfuß zeigen. Die Bildgebung ist aber v. a. notwendig, um andere Erkrankungen wie Normaldruckhydrozephalus, Multiinfarktdemenz und zerebelläre Läsionen auszuschließen.
Abstract
Clinical/methodical issue
Cerebellar syndromes result in distinct clinical symptoms, such as ataxia, dysarthria, dysmetria, intention tremor and eye movement disorders.
Standard radiological methods
In addition to the medical history and clinical examination, imaging is particularly important to differentiate other diseases, such as hydrocephalus and multi-infarct dementia from degenerative cerebellar diseases. Degenerative diseases with cerebellar involvement include Parkinson’s disease, multiple system atrophy as well as other diseases including spinocerebellar ataxia.
Achievements
In addition to magnetic resonance imaging (MRI), nuclear medicine imaging investigations are also helpful for the differentiation.
Practical recommendations
Axial fluid-attenuated inversion recovery (FLAIR) and T2-weighted sequences can sometimes show a signal increase in the pons as a sign of degeneration of pontine neurons and transverse fibers in the basilar part of the pons. The imaging is particularly necessary to exclude other diseases, such as normal pressure hydrocephalus (NPH), multi-infarct dementia and cerebellar lesions.
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W. Reith, S. Roumia und P. Dietrich geben an, dass kein Interessenkonflikt besteht.
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Reith, W., Roumia, S. & Dietrich, P. Degenerative Kleinhirnerkrankungen und Differenzialdiagnosen. Radiologe 56, 976–982 (2016). https://doi.org/10.1007/s00117-016-0180-0
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DOI: https://doi.org/10.1007/s00117-016-0180-0