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Parasitäre Erkrankungen des ZNS

Parasitic diseases of the central nervous system

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Intensivmedizin und Notfallmedizin

Summary

Epidemiology, modes of infection, and predisposing factors need to be known in order to diagnose parasitic diseases of the nervous system in time and to allow timely initiation of the specific antiparasitic therapy. In this review, all those parasites, protozoa and helminths, which have the capacity to invade the central nervous system, leading to critical disease, are discussed in terms of their epidemiology, clinical neurological syndromes, their typical course, best diagnostic methods, differential diagnosis and antiparasitic chemotherapy as well as adjunctive therapeutic strategies. It is mainly the timely diagnosis which is based on appropriate history taking and the early recognition of typical syndromes as well as the correct diagnostic work up which allows the appropriate antiparasitic chemotherapy. Intensive care measures in CNS parasitoses include management of increased intracranial pressure, diffuse brain edema, acute obstructive hydrocephalus, multiorgan dysfunction, and early neurosurgical decompressive interventions. In some parasitic diseases of the CNS, steroid therapy is indicated (e. g. neurocysticercosis, trichinosis), in others, steroid therapy may be deleterious (e. g. cerebral malaria).

Zusammenfassung

Die Epidemiologie, die Infektionswege, sowie prädisponierende Faktoren müssen ausreichend bekannt sein, um parasitäre Erkrankungen des Nervensystems rechtzeitig zu erkennen und die frühzeitige Einleitung einer spezifischen antiparasitären Therapie zu erlauben. In dieser Übersicht werden alle Parasiten, Protozoen und Helminthen, die imstande sind, das zentrale Nervensystem zu invadieren und damit zu einer potentiell intensivpflichtigen Krankheit zu führen, in bezug auf ihre Epidemiologie, klinisch neurologische Syndrome, ihren typischen Verlauf, die bestmöglichen diagnostischen Schritte, ihre Differenzialdiagnosen sowie die antiparasitären und adjuvanten therapeutischen Strategien dargestellt. Die essentiell notwendige rechtzeitige Diagnose basiert auf eine appropriate Anamneseerhebung, das Erkennen der typischen Symptome, sowie der Einleitung des korrekten diagnostischen Procedere; erst dadurch wird die richtige antiparasitäre Chemotherapie rechtzeitig ermöglicht. Intensivmedizinische Maßnahmen, die bei ZNS-Parasitosen notwendig sein können, inkludieren das Management eines erhöhten intrakraniellen Drucks, eines diffusen Hirnödems, eines akuten obstruktiven Hydrocephalus, vor allem aber Multiorganversagen und die Indikation zur rechtzeitigen/frühen neurochirurgischen Dekompressions- Intervention. Nur bei einigen parasitären Erkrankungen des ZNS ist eine Steroidtherapie indiziert (z. B. Neurozystizerkose oder Trichinose), demgegenüber sind Steroide bei anderen ZNS-Parasitosen (z. B. zerebrale Malaria), wie auch Heparinisierung kontraindiziert.

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  1. Department of Neurology, University Hospital Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria

    E. Schmutzhard &  R. Helbok

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  1. E. Schmutzhard
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Correspondence to E. Schmutzhard.

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Serie: Die Intensivtherapie bei Entzündungen des Nervensystems Herausgegeben von U. Meyding-Lamadé, V. Schuchardt und E. Schmutzhard

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Schmutzhard, E., Helbok, R. Parasitäre Erkrankungen des ZNS. Intensivmed 41, 555–564 (2004). https://doi.org/10.1007/s00390-004-0548-7

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