Zusammenfassung
Aneurysmatischen Subarachnoidalblutungen (aSAB) liegt eine multifaktorielle Genese
zugrunde. Befragungen rehabilitativ behandelter Patienten nach aSAB ergaben in 16
% der Fälle das Vorliegen unterschiedlicher Infektionserkrankungen, die im zeitlichen
Zusammenhang mit dem Blutungsereignis standen. Die Analyse von 1900 Krankenakten und
o. g. zusätzliche Befragung von 384 Patienten der Analysegruppe ergab in 61 Fällen
eine in der Vorgeschichte stattgehabte VZV-Infektion, davon in 14 Fällen eine akute
Zosterinfektion, die mit dem Blutungsereignis in unmittelbarem zeitlichen Zusammenhang
stand. Bei diesen Patienten wurden auffällige lokalisatorische Zusammenhänge zwischen
Zosterexanthem und Lokalisation des rupturierten Aneurysmas beobachtet. Unter anderem
war bei allen Patienten (6) mit Ruptur eines Arteria-communicans-anterior-Aneurysmas
(AcoA) klinisch der 1. Trigeminusast (T1) von der Herpesinfektion betroffen. In 11
Fällen (79 %) lagen kernspintomographisch nachweisbare Ischämiezeichen vor. Die Ergebnisse
werden unter vergleichender Literaturanalyse diskutiert. Es wird die Möglichkeit einer
Viruspropagation durch gangliovaskuläre Verbindungen postuliert. Die Häufung komplizierender
zerebraler Infarzierungen ist durch vaskulitische Veränderungen der betroffenen Gefäße
zu erklären, welche auch in Einzelfällen der Beobachtungsgruppe kernspintomographisch
nachweisbar waren.
Abstract
Aneurysmatic subarachnoid hemorrhages have a multifactorial pathogenesis. Interviews
of patients who had undergone rehabilitation in accordance with aSAB disclosed that
various infectious diseases had been present in 16 % of cases. These showed a chronological
correlation with the hemorrhage event. Analysis of 1900 patient records and the survey
of 384 patients mentioned above revealed that a VZV infection had occurred in the
history in 61 patients. Of these, 14 cases had an acute zoster infection immediately
coinciding with the hemorrhage. In these patients, there were striking correlations
between the location of the zoster exanthema and the location of the ruptured aneursysm.
Amongst other abnormalities, the first trigeminal branch (T1) was clinically affected
by the herpes infection in all patients (6) with rupture of an anterior communicating
artery aneurysm (AcoA). In 11 cases (79 %), nuclear magnetic resonance imaging showed
demonstrable signs of ischemia. The results are discussed in conjunction with a comparative
analysis of the literature. The possibility of gangliovascular virus dissemination
is postulated. The increased occurrence of complicating cerebral infarctions can be
explained by vasculitic lesions in the affected vessels which could also be demonstrated
by MRI in individual patients of the groups observed.
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Dr. med. Dorothea Osenberg
Klinik Holthausen
Am Hagen 20
45527 Hattingen
Email: osenberg@klinik-holthausen.de
