Akute Hemiparese und ipsilaterales Horner-Syndrom – Eindeutige Indikation zur intravenösen Thrombolyse?

Zusammenfassung

Die Symptomtrias „akute Hemiparese, ipsilaterales Horner-Syndrom (v. a. Miosis und Ptosis) und Nackenschmerzen“ gilt als typisches Syndrom eines spinalen Infarktes bei akutem Verschluss einer Vertebralarterie (Opalski-Syndrom). Gleichermaßen kann ein spontanes zervikales epidurales Hämatom mit unilateraler Kompression des zervikalen Myelons (Brown-Séquard-Syndrom) zu dieser Symptomtrias führen. Die akuten Therapieoptionen sind divergent (rekanalisierende Therapie vs. operative Entlastung). Eine korrekte Diagnosestellung kann in der Akutphase schwierig sein, insbesondere wenn klinisch die Hemiparese im Vordergrund steht. Der vorgestellte Fall soll auf diese wichtige Differenzialdiagnose aufmerksam machen und Orientierungshilfen im Akutmanagement geben.

Abstract

The symptom triad “acute hemiparesis, ipsilateral Horner syndrome (i. e., miosis and ptosis) and neck pain” is supposed to be the typical syndrome of a spinal infarction resulting from an acute occlusion of a vertebral artery (Opalski syndrome). A spontaneous cervical epidural haematoma with unilateral compression of the cervical spinal cord (Brown-Séquard syndrome) can lead to this symptom triad as well. The acute therapeutic options may be completely diverse (thrombolytic therapy vs. surgical decompression). A definite diagnosis during acute onset can be difficult, especially if the hemiparesis dominates the clinical symptoms. The case presented here should point out this important differential diagnosis and help to improve orientation in acute management.

Schlüsselwörter

Hemiparese und ipsilaterales Horner-Syndrom - spontanes zervikales epidurales Hämatom - Opalski Syndrom - Brown-Séquard-Syndrom - Lysetherapie

Keywords

hemiparesis and ipsilateral Horner syndrome - spontaneous cervical epidural haematoma - Opalski syndrome - Brown-Séquard syndrome - intravenous thrombolysis

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