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Erschienen in: InFo Neurologie + Psychiatrie 6/2020

23.06.2020 | Magnetresonanztomografie | Zertifizierte Fortbildung Neurologie

Kleine subkortikale Ischämien

Lakunäre Schlaganfälle

verfasst von: Dr. med. Ewgenia Barow, Prof. Dr. med. Götz Thomalla

Erschienen in: InFo Neurologie + Psychiatrie | Ausgabe 6/2020

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Auszug

Lakunäre Schlaganfälle sind kleine subkortikale Ischämien, die bis zu einem Drittel aller Schlaganfälle verursachen. Es ist allerdings wichtig, zwischen einem möglichen lakunären Syndrom und einem nachgewiesenen lakunären Schlaganfall zu differenzieren. Die Diagnose eines lakunären Schlaganfalls kann nicht nur auf der Basis der klinischen Präsentation eines lakunären Syndroms gestellt werden. Die den lakunären Infarkten zugrunde liegenden pathophysiologischen Mechanismen sind vielfältiger als Mikroangiopathie, auch kleine Embolien können Ursache lakunärer Infarkte sein.
Literatur
1.
Zurück zum Zitat Sudlow CL, Warlow CP. Comparable studies of the incidence of stroke and its pathological types: results from an international collaboration. International Stroke Incidence Collaboration. Stroke 1997;28:491-9 Sudlow CL, Warlow CP. Comparable studies of the incidence of stroke and its pathological types: results from an international collaboration. International Stroke Incidence Collaboration. Stroke 1997;28:491-9
2.
Zurück zum Zitat Dechambre A. Mémoire sor la curabilité du ramollissement cérébral. Gaz Med Paris1938;6:305 Dechambre A. Mémoire sor la curabilité du ramollissement cérébral. Gaz Med Paris1938;6:305
3.
Zurück zum Zitat Marie P. Des foyers lacunaires de desintegration et de differents autres etats cavitaires du cerveau. Rev Med (Paris) 1901;21:281-98 Marie P. Des foyers lacunaires de desintegration et de differents autres etats cavitaires du cerveau. Rev Med (Paris) 1901;21:281-98
4.
Zurück zum Zitat Fisher CM. Lacunes: Small, Deep Cerebral Infarcts. Neurology 1965;15:774-84 Fisher CM. Lacunes: Small, Deep Cerebral Infarcts. Neurology 1965;15:774-84
5.
Zurück zum Zitat Fisher CM. Lacunar strokes and infarcts: a review. Neurology 1982;32:871-6 Fisher CM. Lacunar strokes and infarcts: a review. Neurology 1982;32:871-6
6.
Zurück zum Zitat Mohr JP et al. Sensorimotor stroke due to thalamocapsular ischemia. Arch Neurol 1977;34:739-41 Mohr JP et al. Sensorimotor stroke due to thalamocapsular ischemia. Arch Neurol 1977;34:739-41
7.
Zurück zum Zitat Arboix A, Marti-Vilalta JL. Expert Rev Neurother 2009;9:179-96 Arboix A, Marti-Vilalta JL. Expert Rev Neurother 2009;9:179-96
8.
Zurück zum Zitat Singer MB, Chong J, Lu D, et al. Diffusion-weighted MRI in acute subcortical infarction. Stroke 1998;29:133-6 Singer MB, Chong J, Lu D, et al. Diffusion-weighted MRI in acute subcortical infarction. Stroke 1998;29:133-6
9.
Zurück zum Zitat Wardlaw JM et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013;12:822-38 Wardlaw JM et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013;12:822-38
10.
Zurück zum Zitat Potter G et al. Associations of clinical stroke misclassification ('clinical-imaging dissociation') in acute ischemic stroke. Cerebrovasc Dis 2010;29:395-402 Potter G et al. Associations of clinical stroke misclassification ('clinical-imaging dissociation') in acute ischemic stroke. Cerebrovasc Dis 2010;29:395-402
11.
Zurück zum Zitat Chamorro A et al. Clinical-computed tomographic correlations of lacunar infarction in the Stroke Data Bank. Stroke 1991;22:175-81 Chamorro A et al. Clinical-computed tomographic correlations of lacunar infarction in the Stroke Data Bank. Stroke 1991;22:175-81
12.
Zurück zum Zitat Arboix A et al. Clinical study of 227 patients with lacunar infarcts. Stroke 1990;21:842-7 Arboix A et al. Clinical study of 227 patients with lacunar infarcts. Stroke 1990;21:842-7
13.
Zurück zum Zitat Donnan GA et al. A prospective study of lacunar infarction using computerized tomography. Neurology 1982;32:49-56 Donnan GA et al. A prospective study of lacunar infarction using computerized tomography. Neurology 1982;32:49-56
14.
Zurück zum Zitat Fisher CM. The arterial lesions underlying lacunes. Acta Neuropathol 1968;12:1-15 Fisher CM. The arterial lesions underlying lacunes. Acta Neuropathol 1968;12:1-15
15.
Zurück zum Zitat Chester EM et al. Hypertensive encephalopathy: a clinicopathologic study of 20 cases. Neurology 1978;28:928-39 Chester EM et al. Hypertensive encephalopathy: a clinicopathologic study of 20 cases. Neurology 1978;28:928-39
16.
Zurück zum Zitat Caso V et al. Clinical significance of detection of multiple acute brain infarcts on diffusion weighted magnetic resonance imaging. J Neurol Neurosurg Psychiatry 2005;76:514-8 Caso V et al. Clinical significance of detection of multiple acute brain infarcts on diffusion weighted magnetic resonance imaging. J Neurol Neurosurg Psychiatry 2005;76:514-8
17.
Zurück zum Zitat Takahashi K et al. The differences of clinical parameters between small multiple ischemic lesions and single lesion detected by diffusion-weighted MRI. Acta Neurol Scand 2002;106:24-9 Takahashi K et al. The differences of clinical parameters between small multiple ischemic lesions and single lesion detected by diffusion-weighted MRI. Acta Neurol Scand 2002;106:24-9
18.
Zurück zum Zitat Seifert T et al. Acute small subcortical infarctions on diffusion weighted MRI: clinical presentation and aetiology. J Neurol Neurosurg Psychiatry 2005;76:1520-4 Seifert T et al. Acute small subcortical infarctions on diffusion weighted MRI: clinical presentation and aetiology. J Neurol Neurosurg Psychiatry 2005;76:1520-4
19.
Zurück zum Zitat Barow E et al. Clinical Characteristics and Outcome of Patients with Lacunar Infarcts and Concurrent Embolic Ischemic Lesions. Clin Neuroradiol 2019, doi:10.1007/s00062-019-00800-5 Barow E et al. Clinical Characteristics and Outcome of Patients with Lacunar Infarcts and Concurrent Embolic Ischemic Lesions. Clin Neuroradiol 2019, doi:10.1007/s00062-019-00800-5
20.
Zurück zum Zitat Fisher CM. Capsular infarcts: the underlying vascular lesions. Arch Neurol 1979;36:65-73 Fisher CM. Capsular infarcts: the underlying vascular lesions. Arch Neurol 1979;36:65-73
21.
Zurück zum Zitat Laloux P et al. Lacunar infarctions due to cholesterol emboli. Stroke 1991;22:1440-4 Laloux P et al. Lacunar infarctions due to cholesterol emboli. Stroke 1991;22:1440-4
22.
Zurück zum Zitat Futrell N et al. Embolic stroke from a carotid arterial source in the rat: pathology and clinical implications. Neurology 1989;39:1050-6 Futrell N et al. Embolic stroke from a carotid arterial source in the rat: pathology and clinical implications. Neurology 1989;39:1050-6
23.
Zurück zum Zitat Macdonald RL et al. Emboli enter penetrating arteries of monkey brain in relation to their size. Stroke 1995;26:1247-50; discussion 50-1 Macdonald RL et al. Emboli enter penetrating arteries of monkey brain in relation to their size. Stroke 1995;26:1247-50; discussion 50-1
24.
Zurück zum Zitat Futrell N. Lacunar infarction: embolism is the key. Stroke 2004;35:1778-9 Futrell N. Lacunar infarction: embolism is the key. Stroke 2004;35:1778-9
25.
Zurück zum Zitat Del Bene A et al. Variation in risk factors for recent small subcortical infarcts with infarct size, shape, and location. Stroke 2013;44:3000-6 Del Bene A et al. Variation in risk factors for recent small subcortical infarcts with infarct size, shape, and location. Stroke 2013;44:3000-6
26.
Zurück zum Zitat Jackson C et al. Are lacunar strokes really different? A systematic review of differences in risk factor profiles between lacunar and nonlacunar infarcts. Stroke 2005; 36:891-901 Jackson C et al. Are lacunar strokes really different? A systematic review of differences in risk factor profiles between lacunar and nonlacunar infarcts. Stroke 2005; 36:891-901
27.
Zurück zum Zitat Jackson C et al. Comparing risks of death and recurrent vascular events between lacunar and non-lacunar infarction. Brain 2005;128:2507-17 Jackson C et al. Comparing risks of death and recurrent vascular events between lacunar and non-lacunar infarction. Brain 2005;128:2507-17
28.
Zurück zum Zitat Besson G et al. J. Risk factors for lacunar infarcts. Cerebrovasc Dis 2000;10:387-90 Besson G et al. J. Risk factors for lacunar infarcts. Cerebrovasc Dis 2000;10:387-90
29.
Zurück zum Zitat Regenhardt RW, Das AS, Lo EH, et al. Advances in Understanding the Pathophysiology of Lacunar Stroke: A Review. JAMA Neurol 2018;75:1273-81 Regenhardt RW, Das AS, Lo EH, et al. Advances in Understanding the Pathophysiology of Lacunar Stroke: A Review. JAMA Neurol 2018;75:1273-81
30.
Zurück zum Zitat National Institute of Neurological D, Stroke rt PASSG. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581-7 National Institute of Neurological D, Stroke rt PASSG. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581-7
31.
Zurück zum Zitat Sandercock P et al. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 2012;379:2352-63 Sandercock P et al. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 2012;379:2352-63
32.
Zurück zum Zitat Caplan LR et al. Should thrombolytic therapy be the first-line treatment for acute ischemic stroke? Thrombolysis--not a panacea for ischemic stroke. N Engl J Med 1997;337:1309-10; discussion 13 Caplan LR et al. Should thrombolytic therapy be the first-line treatment for acute ischemic stroke? Thrombolysis--not a panacea for ischemic stroke. N Engl J Med 1997;337:1309-10; discussion 13
33.
Zurück zum Zitat Alvarez-Sabin Jet al. Factors influencing haemorrhagic transformation in ischaemic stroke. Lancet Neurol 2013;12:689-705 Alvarez-Sabin Jet al. Factors influencing haemorrhagic transformation in ischaemic stroke. Lancet Neurol 2013;12:689-705
34.
Zurück zum Zitat Shobha N, Fang J, Hill MD Do lacunar strokes benefit from thrombolysis? Evidence from the Registry of the Canadian Stroke Network. Int J Stroke 2013;8 Suppl A100:45-9 Shobha N, Fang J, Hill MD Do lacunar strokes benefit from thrombolysis? Evidence from the Registry of the Canadian Stroke Network. Int J Stroke 2013;8 Suppl A100:45-9
35.
Zurück zum Zitat Griebe M et al. Thrombolysis in patients with lacunar stroke is safe: an observational study. J Neurol 2014;261:405-11 Griebe M et al. Thrombolysis in patients with lacunar stroke is safe: an observational study. J Neurol 2014;261:405-11
36.
Zurück zum Zitat Lahoti S et al. Thrombolysis in ischemic stroke without arterial occlusion at presentation. Stroke 2014;45:2722-7 Lahoti S et al. Thrombolysis in ischemic stroke without arterial occlusion at presentation. Stroke 2014;45:2722-7
37.
Zurück zum Zitat Eggers CCJ et al. The efficacy of thrombolysis in lacunar stroke - evidence from the Austrian Stroke Unit Registry. Eur J Neurol 2017;24:780-7 Eggers CCJ et al. The efficacy of thrombolysis in lacunar stroke - evidence from the Austrian Stroke Unit Registry. Eur J Neurol 2017;24:780-7
38.
Zurück zum Zitat Barow E et al. Functional Outcome of Intravenous Thrombolysis in Patients With Lacunar Infarcts in the WAKE-UP Trial. JAMA Neurol 2019;76:641-49 Barow E et al. Functional Outcome of Intravenous Thrombolysis in Patients With Lacunar Infarcts in the WAKE-UP Trial. JAMA Neurol 2019;76:641-49
39.
Zurück zum Zitat Chalela JA et al. Reversal of perfusion and diffusion abnormalities after intravenous thrombolysis for a lacunar infarction. J Neuroimaging 2003;13:152-4 Chalela JA et al. Reversal of perfusion and diffusion abnormalities after intravenous thrombolysis for a lacunar infarction. J Neuroimaging 2003;13:152-4
40.
Zurück zum Zitat Kwok CS et al. Efficacy of antiplatelet therapy in secondary prevention following lacunar stroke: pooled analysis of randomized trials. Stroke 2015;46:1014-23 Kwok CS et al. Efficacy of antiplatelet therapy in secondary prevention following lacunar stroke: pooled analysis of randomized trials. Stroke 2015;46:1014-23
41.
Zurück zum Zitat Bath PM et al. Pharmacological treatment and prevention of cerebral small vessel disease: a review of potential interventions. Int J Stroke 2015;10:469-78 Bath PM et al. Pharmacological treatment and prevention of cerebral small vessel disease: a review of potential interventions. Int J Stroke 2015;10:469-78
42.
Zurück zum Zitat Johnston SC et al. Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA. N Engl J Med 2018;379:215-25 Johnston SC et al. Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA. N Engl J Med 2018;379:215-25
43.
Zurück zum Zitat Wang Y et al. Acute dual antiplatelet therapy for minor ischaemic stroke or transient ischaemic attack. BMJ 2019;364:l895 Wang Y et al. Acute dual antiplatelet therapy for minor ischaemic stroke or transient ischaemic attack. BMJ 2019;364:l895
Metadaten
Titel
Kleine subkortikale Ischämien
Lakunäre Schlaganfälle
verfasst von
Dr. med. Ewgenia Barow
Prof. Dr. med. Götz Thomalla
Publikationsdatum
23.06.2020
Verlag
Springer Medizin
Erschienen in
InFo Neurologie + Psychiatrie / Ausgabe 6/2020
Print ISSN: 1437-062X
Elektronische ISSN: 2195-5166
DOI
https://doi.org/10.1007/s15005-020-1362-x

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