Bedeutung des frühen transkraniellen Ultraschalls beim Hirninfarkt

Zusammenfassung

Die transkranielle Ultraschalldiagnostik ist eine wichtige Untersuchungsmethode bei der Abklärung des akuten Hirninfarkts, weil sie wiederholbar und am Patientenbett einsetzbar ist. Der innerhalb der ersten Stunden nach Symptombeginn erfasste Gefäßbefund ist ein eindeutiger prognostischer Parameter und von anderen Variablen unabhängig. Insbesondere haben Patienten mit primär offenen intrakraniellen Gefäßen im Vergleich zum Mediaastoder -hauptstammverschluss eine mehr als elffach höhere Chance, sich klinisch innerhalb der ersten vier Tage nach Symptombeginn zu bessern. Dieser Befund ist unter wissenschaftlichen Aspekten wichtig, da eine Stratifizierung nach dem Gefäßbefund bei klinischen Studien notwendig ist.

Insbesondere die Verlaufsbeobachtung der Rekanalisation ist eine Domäne der neurologischen Ultraschalldiagnostik, außerdem einer der wichtigsten Parameter der Akutbehandlung und eng mit dem klinischen Verlauf verknüpft. Allerdings ist ein starres Rekanalisationszeitfenster nach aktuellen Untersuchungen nicht haltbar, sondern auch Patienten mit später Rekanalisation können davon profitieren.

Summary

Transcranial ultrasound is an important diagnostic tool in the work-up of acute stroke because of its repeatability and bedside applicability.The vascular status within the first hours after stroke onset has a high prognostic value and is independent from other variables. Particularly patients with primary patent intracranial vessels have a more than eleven fold chance for clinical improvement within the first four days, compared with patient with middle cerebral artery branch or main stem occlusions. However, this has scientific implications, because in clinical studies obviously stratification for the vascular status is necessary.

Monitoring of recanalization is a domain of transcranial ultrasound. Recanalization is one of the most important single variables of stroke treatment and tightly connected with clinical outcome. However, in a recent study a fixed recanalization time window does not exist. Even patients with late recanalization can profit.

Schlüsselwörter

Transkranielle Dopplersonografie - transkranielle Farbduplexsonografie - akuter Hirninfarkt - Prognose - Rekanalisation

Keywords

Transcranial doppler sonograph - transcranial colour-coded duplex sonograph - acute stroke - prognosis - recanalization

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