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Klinisch stumme Hirninfarkte

Silent brain infarcts

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Zusammenfassung

Klinisch stumme Hirninfarkte werden im Zuge immer häufigerer und zudem verfeinerter zerebraler Bildgebungsverfahren zunehmend diagnostiziert. Altersabhängig finden sich in der Normalbevölkerung in bis zu 30% der Untersuchten klinisch stumme Hirninfarkte. Der Begriff „klinisch stumm“ ist für Infarkte reserviert, zu denen es keine Anamnese und keinen Befund eines Insultsyndroms gibt. Die Wahrnehmung und die Wiedergabe der Symptome eines Insultes sind abhängig von Alter, Bildung und ethnischem Hintergrund. Langfristig rufen stumme Hirninfarkte oft erhebliche kognitive Störungen und andere Defizitsyndrome hervorrufen, die von der klassischen Definition des Insultes nicht erfasst werden. Die Risikofaktoren klinisch manifester Insulte und klinisch stummer Hirninfarkte unterscheiden sich nicht. Klinisch stumme Hirninfarkte sind zumeist subkortikal im Marklager oder in den Basalganglien lokalisiert, nur etwa 10% dieser Infarkte liegen kortikal. Aufgrund der Gleichheit der Risikofaktoren für stumme und manifeste Hirninfarkte sollten Patienten mit stummen Hirninfarkten intensiv auf mögliche Insultursachen untersucht werden.

Summary

Silent brain infarctions are frequently found by modern cerebral imaging. Up to 30% of persons without a clinical history of stroke were found to have silent brain infarction in epidemiological studies. “Silent” refers to ischemic brain lesions for which no matching clinical syndrome can be found based on history or clinical investigation. Age, education, and ethnic background have a strong impact on noticing and reporting stroke symptoms. The current clinical definition of stroke is insensitive for cognitive deficits which can also be caused by brain infarctions. The majority of silent brain infarctions are localized in the subcortical white matter of the brain; however, about 10% of silent brain infarctions are cortical. Silent brain infarctions are strongly associated with stroke risk factors and comorbidities that are known to cause clinically overt stroke. Silent brain infarctions are 5 to 10 times more frequent than clinically overt strokes. Silent brain infarctions as defined by DWI lesions on MRI imaging are a frequent finding during operative or interventional procedures and their monitoring may help improve the respective techniques in order to decrease the risk of periprocedural stroke.

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  1. Klinik und Poliklinik für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Str. 33, 48129, Münster, Deutschland

    M.A. Ritter, R. Dittrich & E.B. Ringelstein

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  1. M.A. Ritter
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Ritter, M., Dittrich, R. & Ringelstein, E. Klinisch stumme Hirninfarkte. Nervenarzt 82, 1043–1052 (2011). https://doi.org/10.1007/s00115-011-3312-9

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