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Aktuelle Neurologie 2014; 41(02): 107-115
DOI: 10.1055/s-0034-1369835
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Gangstörungen und Stürze bei älteren Patienten mit zerebraler Mikroangiopathie – Klinische Präsentation, Klassifikation, Diagnostik und Therapie

Gait Disturbances and Falls in Elderly Persons with Cerebral Microangiopathy – Clinical Presentation, Classification, Diagnostics and Therapy
C. Blahak
1   Neurologische Klinik, Universitätsmedizin Mannheim
,
H. Bäzner
2   Neurologische Klinik, Klinikum Stuttgart
› Author Affiliations
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Publication History

Publication Date:
11 March 2014 (online)

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Zusammenfassung

Beeinträchtigungen der Mobilität mit einer Gangstörung und Sturzereignissen sind eine wichtige Ursache für Morbidität und Mortalität bei älteren Personen. Angesichts der demografischen Entwicklung führt dies zu zunehmenden medizinischen und soziökonomischen Belastungen der Gesellschaft.

Als ein bedeutender Faktor für Gangstörungen und Sturzereignisse konnten in der letzten Dekade Veränderungen der weißen Hirnsubstanz im Sinne einer zerebralen Mikroangiopathie identifiziert werden. Eine vielversprechende Theorie zur Erklärung der häufig progredienten motorischen Störung bezieht sich auf das komplexe motorische Netzwerk, welches die Intaktheit der zentralen Koordination von Stand und Gang gewährleistet. Dieses Netzwerk wird durch eine kritische Zahl und Ausdehnung von Läsionen in subkortikalen Regionen in seiner Integrität bedroht.

Bislang fehlt allerdings ein klarer Rahmen für die Diagnosestellung und Klassifikation von Gangstörungen bei zerebraler Mikroangiopathie. Die vorliegende Übersichtsarbeit erläutert die klinische Präsentation, einen Vorschlag zur Klassifikation, relevante Diagnostik und mögliche therapeutische Strategien von Gangstörungen und Stürzen bei älteren Patienten mit zerebraler Mikroangiopathie.

Abstract

Impairments in mobility accompanying gait disturbances and falls are important causes of morbidity and mortality in the elderly. In view of demographic developments, these lead to increasing medical and socioeconomic burden on the society.

In the past decade, white matter lesions in the sense of cerebral microangiopathy have been identified as an important factor in gait disturbance and falls. A very promising theory for explaining the frequently progressive motor disturbance refers to the complex motor network that ensures the intactness of central coordination of stance and gait. The integrity of this network is endangered by the critical number and expansion of lesions in the subcortical regions.

Until now, however, there has been a lack of a clear framework for diagnosis and classification of gait disturbances in cerebral microangipathy. The present review throws light on clinical presentations, makes a suggestion for classification, and describes relevant diagnostic and possible therapeutic strategies for gait disturbances and falls in elderly patients with cerebral microangiopathy.

Schlüsselwörter

Gangstörung - Stürze - zerebrale Mikroangiopathie - subkortikale vaskuläre Enzephalopathie

Keywords

gait disturbances - falls - cerebral microangiopathy - subcortical vascular encephalopathy - elderly
 

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