Zusammenfassung
Auf der einen Seite sind kardiale Erkrankungen häufige
Ursache neurologischer Notfälle. Andererseits werden akut
neurologische Erkrankungen von systemischen, vor allem kardialen
und pulmonalen Komplikationen begleitet. Thema dieser Übersicht
sind die kardialen Folgen von Hirnschädigungen. Unabhängig
von der Art der Hirnerkrankung spielt die zentrale Sympathikus-Aktivierung
die entscheidende pathophysiologische Rolle. Dadurch werden autonome
Herzfunktionen beeinflusst. EKG-Veränderungen, Herzenzymanstieg,
Rhythmusstörungen, bis hin zum plötzlichen Herztod
sind die Folge. Wenn die Herzschädigung Folge der zerebralen
autonomen Störung ist, ist die Behandlung der Grundkrankheit
entscheidend für die Besserung der systemischen Symptome.
Die Erkrankungen (Stress-Kardiomyopathie, neurogenes Lungenödem)
haben dann eine gute Prognose. Für die zukünftige
Planung von Studien zur Therapie der neurogen-kardialen Störungen
wird die Zusammenfassung der verstreut definierten Erkrankungen
wichtig sein, weil diese eine gemeinsame pathopysiologische Grundlage
haben.
Abstract
Cardial diseases are common causes of neurological emergencies.
On the other hand, acute neurological disorders go along with systemic
abnormalities, in particular they show cardial and pulmonary complications.
This review is focused on the cardial consequences of cerebral lesions. Independent
on the etiology of the brain disorder, the central activation of
the adrenergic system plays a key role in the pathophysiology. The adrenergic
stimulation modulates cardial function. ECG-changes, elevated cardial
enzymes, arrhythmias, and sudden cardial death can be the consequences.
In these cases, the adequate treatment of the neurological disorder
is essential for the improvement of systemic symptoms. The cardial
disorders (apical ballooning cardiomyopathy, neurogenic pulmonary
edema) then have a favourable prognosis. For future studies on treatment
of neurogenic-cardial disorders, the classification of the differently
defined disorders based on their common pathophysiology will be
essential.
Schlüsselwörter
Stress-Kardiomyopathie - Tako-Tsubo-Kardiomyopathie - neurogenes Lungenödem - Subarachnoidalblutung
- Hirndruck
Keywords
left apical ballooning syndrome - tako-tsubo cardiomyopathy - neurogenic pulmonary
edema - subarachnoid hemorrhage - intracranial pressure
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PD Dr. med. Klaus Jahn
Neurologische Klinik und Poliklinik
Klinikum
der Universität München
Standort
Großhadern
Marchioninistr. 15
81377
München
Phone: 089/7095-3671
Fax: 089/7095-6671
Email: klaus.jahn@med.uni-muenchen.de
