Bildgebung der Arteria-vertebralis-Dissektion bei Kindern

Die VAD (Dissektion der A. vertebralis) ist eine häufige Ursache für eine seltene Erkrankung, den PCAIS (pädiatrischer arterieller ischämischer Schlaganfall im hinteren Kreislauf des Gehirns). Sie kann zu einer fortschreitenden Arteriopathie und rezidivierenden Schlaganfällen führen. Die Autoren geben einen Überblick über die charakteristischen Bildgebungsmerkmale und die optimierte Bildgebung der VAD und des assoziierten PCAIS.

Kernaussagen

• Multifokale isolierte PCAIS-Läsionen (aufgrund von Thromboembolien von Gefäß zu Gefäß) und Schlaganfälle unterschiedlichen Alters, die bei der ersten Bildgebung entdeckt werden, deuten stark auf eine VAD hin. In einigen Fällen sind zum Zeitpunkt der ersten Bildgebung nur chronische Infarkte zu sehen.

• Intrakranielle MR- oder CT-Angiogramme können abrupte Arterienverschlüsse im hinteren Kreislauf aufgrund von Gefäß-zu-Gefäß-Thromboembolien zeigen. Diese Verschlüsse deuten stark auf eine VAD als Ursache hin und sollten Anlass für eine zervikale vaskuläre Bildgebung sein, falls vorhanden.

• Die meisten VAD bei Kindern treten auf der Ebene von C2 auf und betreffen typischerweise das horizontale proximale V3-Segment oder den angrenzenden V2/V3-Übergang. Das V3-Segment kann aufgrund seiner Nähe zum lateralen Aspekt des beweglichen atlantoaxialen Gelenks besonders anfällig sein.

• Im Vergleich zur Dissektion der A. carotis stellt die VAD besondere Herausforderungen. Zu den anatomischen Merkmalen, die einen alternativen Ansatz erfordern, gehören der umgebende Knochen, die im Allgemeinen geringere Größe der Arterie, die Tortuosität des V3-Segments und der periarterielle Venenplexus.

• Eine zervikale arterielle Dissektion, insbesondere eine Dissektion im hinteren Kreislauf, kann sich im Laufe der Zeit verändern. Fast 50% der Gefäßanomalien entwickeln sich innerhalb des ersten Jahres fort, und einige arterielle Anomalien können erst bei der Nachuntersuchung entdeckt werden.

Schlüsselwörter

Arteria-vertebralis-Dissektion - PCAIS - Kinder - Schlaganfallrezidiv - Bildgebung

Publication History

Article published online:
01 January 2025

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