Juveniler Schlaganfall – Ätiologie, Diagnostik und Therapie

Zusammenfassung

Der juvenile Schlaganfall ist von der Mehrzahl der Autoren definiert als zerebraler Infarkt bei Patienten, die älter als 18 Jahre, jedoch jünger als 45 (oder 55) Jahre sind und stellt eine ätiologiediagnostische Herausforderung an den behandelnden Arzt dar. Die Angaben zur Prävalenz juveniler Schlaganfälle variieren zwischen 4,5 % und 12,3 % aller Schlaganfälle. Häufige Ursachen juveniler Schlaganfälle umfassen Makro- und Mikroangiopathien sowie kardiale Embolien. Darüber hinaus sind auch seltenere Ursachen bedeutsam u. a. hämatologische Krankheitsbilder, Drogenkonsum, orale Kontrazeption, nicht arteriosklerotische Gefäßkrankheiten, Stoffwechselerkrankungen oder Migräne. Oft bleibt die Ursache jedoch auch nach umfassender Abklärung kryptogen. Angesichts der häufig klinisch nicht vordergründig ersichtlichen Ursachen und dem breiten ätiologischen Spektrum ist bei juvenilen Schlaganfallpatienten eine umfassende diagnostische Abklärung erforderlich. Neben einer genauen Anamnese (u. a. Kopfschmerzanamnese, Substanzkonsumanamnese und Familienanamnese) und körperliche Untersuchung (u. a. dermatologische und autoimmune Stigmata) sind laborchemische (u. a. Liquorstudium und Vaskulitisserologie) und apparative Untersuchungen (u. a. Langzeit-EKG-Messung, transösophageale Echokardiografie und kranielle Magnetresonanztomografie) zielführend.

Abstract

Juvenile stroke, commonly defined as stroke in patients younger than 45 or 50 years, is diagnostically challenging. Prevalence varies between 4.5 and 12.3 % of all strokes. While frequent causes of juvenile stroke include cardiac embolism, macroangiopathies and microangiopathies, a variety of other mechanisms such as hematologic diseases, drug consumption, contraception, and migraine can also induce juvenile stroke. However, even after exhaustive diagnostic assessment, the underlying mechanism frequently remains cryptogenic. Due to its clinical heterogeneity and broad etiological spectrum, juvenile stroke requires thorough diagnostic assessment, in particular when cardiovascular risk factors are absent. Beside focused medical history (including history of headaches, drug consumption and family medical history) and physical examination (including assessment for cutaneous and autoimmune stigmata), laboratory assessment (including cerebrospinal fluid analysis and vasculitis assessment) and cardiovascular assessment (including holter ECG, transesophageal echocardiography and cranial MRI) constitute relevant diagnostic techniques in the assessment of juvenile stroke.

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