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Schlaganfall bei Kindern und Jugendlichen

Stroke in children and adolescents

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Zusammenfassung

Das Auftreten eines Schlaganfalls bei Kindern und Jugendlichen stellt ein seltenes kritisches Ereignis dar, das mit einer relevanten Morbidität und Mortalität verbunden ist. Neben dem individuellen Leid für die jungen Patienten und der Belastung für die betroffenen Familien ist ein Schlaganfall durch notwendige langfristige rehabilitative Maßnahmen auch mit hohen Folgekosten für das Gesundheitssystem verbunden. Eine frühzeitige Diagnosestellung ist von großer therapeutischer Bedeutung. Aufgrund der Seltenheit der Erkrankung und der vielfältigen klinischen Symptomatik wird die Diagnose oft deutlich verzögert gestellt. Klinisches Leitsymptom bei Kindern und Jugendlichen ist ein akutes, fokal-neurologisches Defizit meist in Form einer Hemiparese, aber auch Kopfschmerzen, Krampfanfälle und Bewusstseinsstörungen können klinisch führend sein. Heutzutage stellt die unmittelbar durchzuführende Magnetresonanztomographie mit diffusionsgewichteten und blutungssensitiven Sequenzen den Goldstandard dar. Die relevantesten Risikofaktoren für das Auftreten eines Schlaganfalls in dieser Alterskohorte sind Vaskulopathien, Infektionen, kardiale Ursachen sowie Koagulopathien. Das Auftreten eines Schlaganfallrezidivs ist abhängig von den zugrunde liegenden Risikofaktoren. In einem nicht unerheblichen Prozentsatz ist mit neurologischer Residualsymptomatik zu rechnen.

Aufgrund einer bis heute unzureichenden Studienlage bei Kindern und Jugendlichen bestehen weiterhin Kontroversen bezüglich des optimalen therapeutischen Vorgehens. Neben der Gabe von Plättchenaggregationshemmern und Vollheparinisierung stellen die systemische intravenöse Thrombolyse und die endovaskuläre Thrombektomie weitere, potenziell wirkungsvolle Therapieoptionen dar. Um eine effektive Therapie frühzeitig zu initiieren, ist die rechtzeitige Diagnosestellung für das Langzeit-Outcome von entscheidender Bedeutung.

Abstract

The occurrence of a stroke in children and adolescents constitutes a rare, critical event that is associated with substantial morbidity and mortality. In addition to the individual suffering for the young patient and the medical burden for the affected family, a stroke is also associated with high follow-up costs for the health system because of the necessary long-term rehabilitative treatment. Establishing an early and prompt diagnosis is of great therapeutic importance. Because of the rarity of the illness and the plethora of clinical manifestations, diagnosis is often delayed. The most frequent clinical presentation is an acute focal-neurological deficit, usually in the form of hemiparesis, but headache, seizures or alteration of consciousness may also be seen. Nowadays, the prompt performance of diffusion-weighted, blood-sensitive magnetic resonance imaging (MRI) constitutes the gold standard. The most relevant risk factors for the occurrence of a stroke in this age cohort are vasculopathies, infections, pathological cardiac conditions or coagulopathies. Recurrence of stroke is dependent on the underlying risk factors. In a substantial percentage of patients, residual neurological deficits are seen.

Owing to a lack of randomized controlled trials in children and adolescents with stroke, the optimal treatment approach is still under debate. In addition to anti-platelet medication and heparinization, systematic intravenous thrombolysis and endovascular thrombectomy are other potentially effective treatment options. The long-term prognosis in children is dependent on establishing a correct, early diagnosis.

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  1. Klinik für Allgemeine Pädiatrie und Neonatologie, Medizinische Fakultät der Universität des Saarlandes, 66421, Homburg, Deutschland

    S. Meyer, M. Flotats-Bastardas & D. Ebrahimi-Fakhari

  2. Klinik für Pädiatrische Kardiologie, Medizinische Fakultät der Universität des Saarlandes, 66421, Homburg, Deutschland

    M. Poryo

  3. Klinik für Diagnostische und Interventionelle Neuroradiologie, Medizinische Fakultät der Universität des Saarlandes, 66421, Homburg, Deutschland

    U. Yilmaz

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S. Meyer, M. Poryo, M. Flotats-Bastardas, D. Ebrahimi-Fakhari und U. Yilmaz geben an, dass kein Interessenkonflikt besteht. Alle Autoren haben der finalen Version des Beitrags vor Einreichung zugestimmt.

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Anteil an der Autorenschaft Sascha Meyer war verantwortlich für die Literaturübersicht, Datenanalyse und -synthese sowie das Verfassen des Manuskripts; Martin Poryo und Marina Flotats-Bastardas waren für Datenanalyse und -synthese sowie für die kritische Durchsicht des Manuskripts zuständig; Daniel Ebrahimi-Fakhari für die kritische Durchsicht des Manuskripts; Umut Yilmaz für alle neuroradiologischen Aspekte im Zusammenhang mit der vorliegenden Arbeit.

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Meyer, S., Poryo, M., Flotats-Bastardas, M. et al. Schlaganfall bei Kindern und Jugendlichen. Radiologe 57, 569–576 (2017). https://doi.org/10.1007/s00117-017-0265-4

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  • DOI: https://doi.org/10.1007/s00117-017-0265-4

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