Maligne Hyperthermie und deren Differenzialdiagnosen

Zusammenfassung

Hyperthermie führt zu einer Beeinflussung verschiedener Körper-Regelgrößen, wobei insbesondere Interaktionen mit dem kardiovaskulären bzw. dem zentralen Nervensystem zu lebensbedrohlichen Folgen führen können. Der vorliegende Beitrag beschreibt die Symptome, die Pathogenese und die Therapieansätze der häufigsten 3 Hyperthermie-Syndrome (maligne Hyperthermie, Serotonin-Syndrom und malignes neuroleptisches Syndrom). Dem Leser die differenzialdiagnostische Abgrenzung dieser 3 Entitäten zu erleichtern, ist das Ziel dieser Übersicht. Weiterhin wird die mögliche Assoziation zwischen Myopathien und Hyperthermie-Syndromen diskutiert.

Abstract

Hyperthermia affects almost all endogenous regulatory systems, where especially cardiovascular and central nervous system interactions can result in life threatening complications. This review illustrates signs and symptoms, pathophysiology and therapeutic options of the three most common hyperthermic syndromes in neurology: malignant hyperthermia, serotonine-syndrom and malignant neuroleptic syndrome. The aim of this contribution is to enable the reader to make the differential diagnosis of these three disease entities. Furthermore the association of other specific myopathies and hyperthermia syndromes is discussed.

Schlüsselwörter

Hyperthermie-Syndrome - maligne Hyperthermie - Serotonin-Syndrom - malignes neuroleptisches Syndrom - Ryanodin-Rezeptor

Key words

hyperthermia-syndromes - malignant hyperthermia - serotonine-syndrome - malignant neuroleptic syndrome - Ryanodine receptor

Literatur

• 1 Albukrek D, Bakon M, Moran D S. et al . Heat-stroke-induced cerebellar atrophy: clinical course, CT and MRI findings.  Neuroradiology. 1997;  39 195-197
• 2 Moschcowitz A. Postoperative heat stroke.  Surg Gynecol Obstet. 1916;  23 441-451
• 3 Denborough M A, Lovell R RH, Maplestone P A. et al . Anaesthetic deaths in a family.  Br J Anaesth. 1962;  34 395
• 4 Robinson R, Carpenter D, Shaw M A. et al . Mutations in RYR1 in malignant hyperthermia and central core disease.  Hum Mutat. 2006;  27 (10) 977-989. Review
• 5 Pongratz D, Heuser M, Koppenwallner C. et al . Central core disease with “structured cores” in Typ II.  Klin Wochenschr. 1976;  54 117-122
• 6 McCarthy T V, Quane K A, Lynch P F. Ryanodine receptor mutations in malignant hyperthermia and central core disease.  Hum Mutat. 2000;  15 410-417
• 7 Marx S O. et al . Coupled gating between cardiac calcium release channels (ryanodine receptors).  Circ Res. 2001;  88 1151-1158
• 8 Mackrill J J. Protein-protein interactions in intracellular Ca²⁺-release channel function.  Biochem J. 1999;  337 345-361
• 9 Wappler F. Malignant hyperthermia.  Europ J o Anaesth. 2001;  18 632-652
• 10 Wappler F, Fiege M, Steinfath M. et al . Evidence for susceptibility to malignant hyperthermia in patients with stress-induced rhabdomyolysis.  Anaesth. 2001;  94 95-100
• 11 Poels P F, Joosten E M, Sengers R C. et al . In vitro contraction test for malignant hyperthermia in patients with unexplained recurrent rhabdomyolysis.  J Neurol Sci. 1991;  105 67-72
• 12 The European Malignant Hyperpyrexia Group . A protocol for the investigation of malignant hyperpyrexia (MH) susceptibility.  Br J Anaesth. 1984;  56 1267-1269
• 13 Adnet P F, Krivosic-Horber R M, Krivosic J. et al . Viability criterion of muscle bundles used in the in vitro contracture test in patients with neuromuscular diseases.  Br J Anaesth. 1994;  72 93-97
• 14 Nisijima K, Shioda K, Yoshino T. et al . Potent serotonin (5-HT)2A receptor antagonists completely prevent development of hyperthermia in an animal model of the 5-HT syndrome.  Brain Res. 2001;  890 23-31
• 15 Sternbach H. The serotonin syndrome.  Am J Psychiatry. 1991;  148 705-713
• 16 Martin T G. Serotonin Syndrome.  Ann Emerg Med. 1996;  28 520-526
• 17 Gillman P K. The serotonin syndrome and its treatment.  J o Psychopharm. 1999;  13 100-109
• 18 Delay J, Pichot P, Lemperiere T. et al . Un neuroleptique majeur non phenothiazine et non reserpine, l’haloperidol, dans le traitement des psychoses.  Ann Med Psychol. 1960;  118  145-152
• 19 Gupta S, Nihalani N D. Neuroleptic malignant Syndrome: A Primary Care Perspective.  Prim Care Companion J Clin Psychiatry. 2004;  6 191-194
• 20 Davis J M, Caroff S N, Mann S C. Treatment of neuroleptic malignant syndrome.  Psych Ann. 2000;  30 325-331
• 21 Nisijima K, Ishiguro T. Neuroleptic malignant syndrome: a study of CSF monoamine metabolism.  Biol Psych. 1990;  27 280-288
• 22 Guerra R F. The role of calcium and peripheral catecholamines in the pathophysiology of neuroleptic malignant syndrome.  Psych Ann. 2000;  30 356-362
• 23 Shalev A, Hermesh H, Munitz H. Mortality from neuroleptic malignant syndrome (Review).  J Clin Psychiatry. 1989;  50 18-25
• 24 Ananth J, Parameswaran S, Gunatilake S. et al . Neuroleptic malignant syndrome and atypical antipsychotic drugs.  J Clin Psychiatry. 2004;  65 464-470
• 25 Rossaint R, Werner C, Zwißler B. Die Anästhesiologie. Heidelberg; Springer 2004