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Aktuelle Neurologie 2014; 41(09): 515-521
DOI: 10.1055/s-0034-1387409
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Klinisch stumme Hirninfarkte

Clinically Silent Brain Infarcts
C. H. Nolte
Klinik und Hochschulambulanz für Neurologie (Direktor: Prof. Matthias Endres), Center for Stroke Research, Charité Campus Benjamin Franklin, Berlin
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Publication History

Publication Date:
14 November 2014 (online)

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Zusammenfassung

Die kontinuierliche Verbesserung moderner bildgebender Verfahren und deren breite Anwendung haben zur Entdeckung von sogenannten klinisch stummen Hirninfarkten geführt. Klinisch stumme Hirninfarkte (KSH) finden sich bei scheinbar gesunden Menschen, vor allem aber bei Patienten mit arteriellem Hypertonus, Nachweis von Arteriosklerose in den Karotiden, Zigarettenkonsum, Vorhofflimmern, metabolischem Syndrom und in Assoziation mit verschiedenen Laborparametern.

Die Bezeichnung „stumm“ bezieht sich häufig auf die Anamnese und eine neurologische Standarduntersuchung und berücksichtigt nicht weniger offensichtliche neuropsychologische Defizite. Insbesondere neuropsychologische Defizite können aber nicht selten bei Patienten mit vermeintlichen KSH gefunden werden. Der Begriff „unentdeckter“ Hirninfarkt wäre somit präziser.

Der Nachweis von KSH geht mit einem erhöhten Risiko für klinisch manifeste Hirninfarkte und für die Entwicklung einer Demenz einher. Patienten mit KSH sollten deshalb hinsichtlich vaskulärer Risikofaktoren und Hirninfarktursachen untersucht und entsprechende Behandlungsmaßnahmen durchgeführt werden.

Abstract

The constant improvement of modern imaging techniques and their widespread use has led to the discovery of so-called clinically silent cerebral infarcts. Clinically silent brain infarcts (also labelled “silent stroke”) can be found in apparently healthy people, but especially in patients with arterial hypertension, evidence of atherosclerosis in the carotid arteries, cigarette smoking, atrial fibrillation, metabolic syndrome and in association with various laboratory parameters.

The term “silent” often refers to the medical history and a standard neurological examination. It does not consider less obvious neuropsychological deficits. In contrast, neuropsychological deficits can be found in patients with putative clinically silent cerebral infarction frequently. The term “uncovered” cerebral infarction may therefore be more accurate.

The detection of clinically uncovered brain infarcts is associated with an increased risk of clinically evident stroke and with the development of dementia. Patients with clinically silent cerebral infarction should therefore be screened for vascular risk factors and possible stroke etiology. Appropriate treatment measures should be implemented.

Schlüsselwörter

klinisch stumme Hirninfarkte - klinisch stumme Hirnläsionen - Rezidivrisiko - Demenz - MRT

Keywords

silent stroke - silent cerebral lesion - risk of recurrence - dementia - MRI
 

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