Durale und leptomeningeale Erkrankungen: Anatomie, Ursachen und Neurobildgebung

Meningeale Läsionen können durch verschiedene Erkrankungen verursacht werden und stellen eine diagnostische Herausforderung dar. Die Autoren untersuchen die Anatomie der Meningen im Gehirn und Rückenmark, um die Lokalisierung und Ausdehnung dieser Erkrankungen besser zu verstehen, und fassen die klinischen und bildgebenden Merkmale verschiedener Erkrankungen zusammen, die zu duralen und/oder leptomeningealen Läsionen führen.

Kernaussagen

• Es gibt 2 verschiedene Anreicherungsmuster der Meningen: das Dura-Arachnoidea-Muster (linear pachymeningeal) und das Pia-Subarachnoidea-Muster (leptomeningeal).

• Bei Neugeborenen und Säuglingen ist eine Meningitis durch Infektion mit Streptokokken der Gruppe B im Vergleich zu einer bakteriellen Meningitis durch andere Erreger häufiger mit der Diagnose eines Hirninfarkts assoziiert (59% der Fälle), oft mit multifokaler oder ausgedehnter Verteilung über mehrere Gefäßterritorien.

• Eine Beteiligung des Ohres (Mittelohrentzündung), der Augenhöhle (z.B. Beteiligung der Tränendrüse, okuläres Granulom oder ischämische Optikusneuropathie) und der Nase (Sinusitis) sind diagnostische Indikatoren für eine ANCA-assoziierte Vaskulitis.

• Metastasen breiten sich über verschiedene Wege aus, z.B. über den Batson-Plexus, perineurale Lymphgefäße, den Subarachnoidalraum (d.h. als sogenannte Abtropfmetastasen), das arterielle System und die Invasion aus angrenzenden Strukturen.

• Verschiedene Erscheinungsbilder von Neuropathien werden mit Immuncheckpoint-Inhibitoren in Verbindung gebracht, darunter kraniale Neuropathie (37%), Polyradikuloneuropathie (32%) sowie Small-Fiber- und autonome Neuropathie (11%) mit oder ohne aseptische Meningitis.

Schlüsselwörter

Meningen - Bildgebung - Meningitis - Autoimmunerkrankungen - Tumoren

Publication History

Article published online:
08 April 2025

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