Zerebrale Mikroangiopathien

Zusammenfassung

Zerebrale Mikroangiopathien, Erkrankungen der kleinen Gefäße (perforierende Arterien und Arteriolen, Kapillaren, Venolen) des Gehirns, sind häufige Ursachen von Schlaganfall und vaskulärer Demenz. Die häufigste Form ist alters- und hypertonieassoziiert, die genauen Pathomechanismen sind jedoch weitgehend unbekannt. Weitere relevante Formen sind die zerebrale Amyloidangiopathie und monogen vererbte Mikroangiopathien, wie bspw. CADASIL als häufigste erbliche Schlaganfallerkrankung. An klinischen Manifestationen finden sich akute (ischämischer oder hämorrhagischer Schlaganfall) und chronische Symptome. Zu letzteren zählen eine Gangstörung, affektive Symptome und eine vaskuläre kognitive Störung mit Defiziten vorwiegend im Bereich der Exekutivfunktionen. In der MRT finden sich charakteristische Gewebeläsionen, u. a. konfluierende T2-Hyperintensitäten (Leukenzephalopathie), Lakunen, Mikroblutungen und kortikale Mikroinfarkte. Zudem kommt es im Verlauf zu einer Gehirnatrophie. Differenzialdiagnostisch müssen die verschiedenen Formen der Mikroangiopathie voneinander abgegrenzt werden, da dies ggf. therapeutische Konsequenzen hat. Ferner stellen entzündliche ZNS-Erkrankungen und Leukodystrophien mögliche Differenzialdiagnosen dar. Therapeutisch steht die Optimierung des Gefäßrisikoprofils im Vordergrund.

Abstract

Cerebral small vessel disease (CSVD) is a frequent cause of stroke and vascular dementia. CSVD is characterized by alterations of the small blood vessels of the brain, i. e. penetrating arteries and arterioles, as well as capillaries and venules. The most common form of CSVD is related to aging and hypertension. The exact mechanisms are, however, poorly understood. Other important forms are cerebral amyloid angiopathy and inherited CSVD, such as CADASIL, the most common monogenic disease leading to stroke. Distinguishing between different forms of CSVD can have clinical implications. CSVD manifests with acute (ischemic or hemorrhagic stroke) and chronic symptoms. The latter include gait and mood disorders and vascular cognitive impairment. The small penetrating vessels cannot be visualized on routine MRI. Neuroimaging relies on characteristic tissue alterations, such as white matter hyperintensities, lacunes, microbleeds, cortical microinfarcts and atrophy. Especially regarding imaging findings, multiple sclerosis and leukodystrophies are relevant differential diagnoses. Current CSVD treatment is focused on the management of vascular risk factors.

Schlüsselwörter

zerebrale Mikroangiopathie - Schlaganfall - vaskuläre kognitive Störung - Magnetresonanztomografie

Keywords

cerebral small vessel disease - stroke - vascular cognitive impairment - magnetic resonance imaging

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