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Symptomatische Dissektion der Arteria carotis interna

Eine seltene Manifestation der autosomal-dominanten polyzystischen Nierenerkrankung?

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Zusammenfassung

Die autosomal-dominante polyzystische Nierenerkrankung (ADPKD) ist eine häufige, genetisch heterogene Erkrankung mit renalen und extrarenalen Manifestationen. Während bei ca. 10% der Patienten zerebrale Aneurysmen gefunden werden, sind andere vaskuläre Manifestationen nur in wenigen Fallberichten beschrieben worden. Wir berichten über einen ADPKD-Patienten mit akutem großem Mediainfarkt, der durch eine subpetröse Dissektion der A. carotis interna verursacht wurde. An der Stelle der Dissektion war nach 6 Monaten ein Pseudoaneurysma nachweisbar. Anhand dieses Falles geben wir eine Übersicht über das Spektrum der neurovaskulären Manifestationen der ADPKD und fassen aktuelle Erkenntnisse zur Pathogenese der Erkrankung zusammen. Schließlich werden spezielle Aspekte der Diagnostik und Therapie von Patienten mit ADPKD und Dissektion diskutiert.

Summary

Autosomal dominant polycystic kidney disease (ADPKD) is a frequent, genetically heterogenous disease with renal and extrarenal manifestations. Intracranial aneurysms are found in about 10% of cases. Other vascular manifestations of ADPKD have been described only in small case series. We report a 44-year-old ADPKD patient who developed acute large middle cerebral artery infarction secondary to subpetrous dissection of the internal carotid artery. Six months after the stroke, pseudoaneurysm was demonstrated on magnetic resonance angiography at the site of a previous dissection. Based on this case report, we review the spectrum of neurovascular manifestations and stroke associated with ADPKD and summarize current concepts of the pathogenesis of this disease. Finally, special aspects of the diagnostic evaluation and therapeutic management in patients with ADPKD and cervicocephalic dissection are discussed.

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Authors and Affiliations

  1. Neurologische Klinik, Ruprecht-Karls-Universität Heidelberg

    R. Veltkamp, Ph. Schönffeldt-Varas & M. Schwaninger

  2. Medizinische Klink IV, Ruprecht-Karls-Universität Heidelberg

    C. Veltkamp

  3. Neuroradiologische Abteilung, Ruprecht-Karls-Universität Heidelberg

    M. Hartmann

  4. Neurologische Klinik, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg

    R. Veltkamp

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  1. R. Veltkamp
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  2. C. Veltkamp
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  3. M. Hartmann
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  4. Ph. Schönffeldt-Varas
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  5. M. Schwaninger
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Correspondence to R. Veltkamp.

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Veltkamp, R., Veltkamp, C., Hartmann, M. et al. Symptomatische Dissektion der Arteria carotis interna. Nervenarzt 75, 149–152 (2004). https://doi.org/10.1007/s00115-003-1644-9

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  • DOI: https://doi.org/10.1007/s00115-003-1644-9

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