Der kardioembolische Hirninfarkt

Zusammenfassung

Kardiale Embolien sind für etwa 20-25% aller Hirninfarkte verantwortlich. Sie nehmen in der Regel einen schwereren klinischen Verlauf als nicht kardioembolisch bedingte Infarkte und tragen ein erhöhtes Rezidivrisiko. Häufig kann aufgrund der klinischen und neuroradiologischen Befundkonstellation eine kardioembolische Genese des Hirninfarktes zwar vermutet werden, zur Bestätigung sind jedoch zahlreiche apparative Zusatzuntersuchungen wie kraniale Kernspintomographie, transkraniale Doppler-Sonographie, transthorakale bzw. transösophageale Echokardiographie und 24-h-EKG notwendig. Die häufigste Ursache für kardioembolische Hirninfarkte ist das nicht-valvuläre Vorhofflimmern. Trotz des nachgewiesenen präventiven Effekts einer oralen Antikoagulation erhalten diese nur ca. 50% der für diese Therapie geeigneten Patienten. Patienten mit einem offenen Foramen ovale haben in der Regel ein geringeres Embolierisiko. Weitere häufige Befundkonstellationen mit dem Risiko einer Hirnembolie sind z.B. rheumatisch bedingte Klappenstenosen, künstliche Herzklap pen, infektiöse und nicht-infektiöse Endokarditis, Vorhofmyxome oder akuter Herzinfarkt. Patienten mit akuten kardioembolischen Schlaganfällen bedürfen einer umfassenden kardialen Diagnostik, einerseits mit dem Ziel einer optimalen Therapie der kardialen Grunderkrankung und andererseits zur optimalen Wahl einer Sekundärprävention des ischämischen Hirninfarktes.

Summary

Cardiac emboli account for about 20-25% of ischemic strokes. Cardioembolic strokes often take a severe clinical course and are associated with an increased risk of recurrence. In many strokes, clinical and neuroradiological findings implicate a cardioembolic source. However, several additional studies such as magnetic resonance imaging, transcranial Doppler sonography, transthoracic or transesophageal echocardiography and Holter monitoring are often necessary. The most frequent cause of cardioembolic stroke is non-valvular atrial fibrillation. Despite the proven preventive effect of oral anticoagulation, only about 50% of patients with atrial fibrillation who do not have any contraindications are anticoagulated. Other cardiac conditions causing ischemic strokes are e.g. stenoses of heart valves, prosthetic heart valves, infectious and non-infectious endocarditis, atrial myxoma or acute myocardial infarction. Patients with acute cardioembolic cerebral infarction require a thorough and comprehensive cardiologic work-up to choose the individually best strategy for treatment of the underlying cardiac disease and for secondary prevention of further ischemic strokes.

Schlüsselwörter

Hirninfarkt - Vorhofflimmern - Antikoagulation - transösophageale Echokardiographie

Keywords

Stroke - atrial fibrillation - anticoagulation - transesophageal echocardiography

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