Zusammenfassung
Die Synkope ist eine akute, kurze und spontan reversible Bewusstlosigkeit mit Tonusverlust der Haltemuskulatur und Sturz, die im Allgemeinen durch eine Minderperfusion des Hirnstammes hervorgerufen wird. Neurokardiogene (vasovagale) Synkopen (NKS) und das posturale Tachykardiesyndrom (POTS) müssen bei Jüngeren, arteriosklerotische Veränderungen wie Subclavian-steal-Syndrom bei Älteren bedacht werden. Seltenere Ursachen sind Vertebraliskompression bei Kopfbewegungen, Basilarismigräne oder Takayasu-Arteriitis.
Syncopes Due to Cerebrovascular Insufficiency
Syncope is an acute short-lasting and spontaneously reversible loss of consciousness with fall, mostly due to a hypoperfusion of the brainstem. Neurocardiogenic syncopes and the postural tachycardia syndrome are a common problem in a young population, whereas arteriosclerotic diseases like subclavian steal syndrome mainly affect elderly patients. Rare causes of syncopes like vertebral artery compression during head rotation, basilar artery migrane or Takayasu arteriitis are reviewed.
Literatur
-
1 Mumenthaler M. Synkopen und Sturzanfälle. Stuttgart, New York; Thieme 1984
-
2
Linzer M, Yang E H, Estes N A. et al .
Diagnosing syncope. Part 1. Value of history, physical examination, and electrocardiography.
Annals Int Med.
1997;
126
986-996
-
3 Melo T P, Bogousslavsky J. Specific manifestations of stroke. In: Ginsberg MD, Bogousslavsky J Cerebrovascular Disease - Pathophysiology, Diagnosis and Management. New York; Raven Press 1998: 961-985
-
4
Bousser M G, Dubois G.
Pertes de connaissance breves au cours des accidents vasculaires.
Ann Med Interne.
1981;
132
300-305
-
5
Davidson E, Rotenberg Z, Fuchs J. et al .
Transient ischemic attack-related syncope.
Clin Cardiol.
1991;
14
141-144
-
6
Zunker P.
Differenzialdiagnose und Management von Synkopen.
Nervenheilkunde.
2000;
19
358-365
-
7
Youde J, Ruse C, Parker S, Fotherby M.
A high diagnostic rate in older patients attending an integrated syncope clinic.
J Am Geriatr Soc.
2000;
48
783-787
-
8 von Büdingen H J, Staudacher T. Evaluation of vertebrobasilar disease. In: Newell DW, Aaslid R Transcranial Doppler. 1. Auflage. New York; Raven Press 1992: 167-195
-
9
Jargiello T, Pietura R, Rakowski P. et al .
Power Doppler imaging in the evaluation of extracranial vertebral artery compression in patients with vertebrobasilar insufficiency.
Eur J Ultrasound.
1998;
3
149-156
-
10
Brown B SJ, Tissington Tatlow W F.
Radiographic studies of the vertebral arteries in cadavers.
Radiology.
1963;
81
80-88
-
11
Sturzenegger M, Newell D W, Douville C M. et al .
Dynamic transcranial Doppler assessment of positional vertebrobasilar ischemia.
Stroke.
1994;
25
1176-1183
-
12
Rossitis S, Volkmann R.
Changes of blood flow velocity indicating mechanical compression of the vertebral arteries during rotation of the head in the normal human measured with transcranial Doppler sonography.
Arch Neuropsiquiat.
1995;
53
26-33
-
13
Yanagihara T, Klass D W, Piepgras D G, Houser O W.
Brief loss of consciousness in bilateral carotid occlussive disease.
Arch Neurol.
1989;
46
858-861
-
14
Bogousslavsky J, Regli F.
Unilateral watershed cerebral infarcts.
Neurology.
1986;
36
373-377
-
15
Nolte C H, Junge-Hülsing G J, Böckeler G, Niehaus L.
Kipptischuntersuchungen bei Patienten mit Karotisstenose/-verschluss.
Klin Neurophysiol.
2000;
31
177
-
16
Diehl R R, Linden D.
Differenzialdiagnose der orthostatischen Dysregulation.
Nervenarzt.
1999;
74
1044-1051
-
17
Low P A, Novak V, Spies J M. et al .
Cerebrovascular regulation in the postural orthostatic tachycardia syndrome (POTS).
Am J Med Sci.
1999;
17
124-133
-
18
Grubb B P, Kosinski D J, Boehm K, Kip K.
The postural orthostatic tachycardia syndrome (POTS). A neurocardiogenic variant identified during head-up tilt table testing.
Pace.
1997;
20
2205-2212
-
19
Braune S, Wrocklage C, Schulte-Mönting J. et al .
Diagnosis of tachycardia syndromes associated with orthostatic symptoms.
Clin Auton Res.
1999;
9
97-101
-
20
Jacob G, Costa F, Shannon J R. et al .
The neuropathic postural tachycardia syndrome.
N Engl J Med.
2000;
343
1008-1014
Dr. med. Andreas Meyer
Abteilung für Neurologie und Epileptologie
ZFP Die Weissenau
Weingartshoferstraße 2
88214 Ravensburg
