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DOI: 10.1055/s-0035-1548893
Aktueller Stellenwert der ultraschallbasierten Rechts-Links-Shunt Diagnostik
Current Neurological Views on Ultrasound-Based Right-Left Shunt DetectionPublikationsverlauf
Publikationsdatum:
30. Juni 2015 (online)
Zusammenfassung
Bei der Ursachenabklärung des ischämischen Schlaganfalls gerade jüngerer Patienten wird die „paradoxe Embolie“ über einen Rechts-Links-Shunt als möglicher Mechanismus diskutiert. Die diagnostischen Maßnahmen zur Sicherung eines Shunts sollen die Ursache sichern und eine Therapieentscheidung begründen helfen. Die transösophageale Echokardiografie (TEE) gilt weithin als Standard, weist aber auch Risiken und Fehlbefunde auf. Eine elegante Methode ist die kontrastmittelgestützte transkranielle Dopplersonografie (cTCD). Sie ist als Screeningmethode und zur Kontrolle der Behandlungsergebnisse (z. B. Schirmverschluß) sehr gut geeignet und erreicht hohe Sensitivitätswerte.
Abstract
The clinical approach in young ischaemic stroke patients to find the pathomechanism is focused on paradoxical embolism. Diagnostic examinations to assess a right-left shunt are required in order to initialize therapeutic options. The transesophageal echocardiography (TEE) is the gold standard for the diagnosis of a patent Foramen ovale (PFO) but has some limitations. A simple method is provided by contrast-enhanced transcranial Doppler sonography (cTCD). cTCD serves as a highly sensitive method for shunt screening and for interventional treatment control.
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