Klinische und radiologische Merkmale des intrakraniellen arteriellen Aneurysmas bei Kindern und Jugendlichen^[1]

Zusammenfassung

Bei Kindern kommen IAA (intrakranielle arterielle Aneurysmen) selten vor. Dennoch sind IAA für mindestens 10 – 15 % aller hämorrhagischen Schlaganfälle in den ersten 2 Lebensjahrzehnten verantwortlich. Traditionelle vaskuläre Risikofaktoren, wie sie in der erwachsenen Bevölkerung weit verbreitet sind, liegen in der pädiatrischen Population gewöhnlich nicht vor, sodass auch die Pathogenese des IAA anders verläuft. Bei der Klassifizierung des IAA im Kindes- und Jugendalter nach den verschiedenen pathogenetischen Mechanismen ergeben sich 8 Kategorien der Pathogenese: idiopathisch, traumatisch, durch übermäßige hämodynamische Belastung bedingt, vaskulopathisch bedingt, infektiös, nicht infektiös-entzündlich, onkologisch und familiär bedingt. Dieser pathogenetische Mechanismus ist der aussagekräftigste Prädiktor für den klinischen Verlauf der Krankheit, für das Ansprechen auf die Behandlung und für die langfristige Prognose. Die pathogenetischen Subtypen des IAA im Kindes- und Jugendalter weisen charakteristische Merkmale auf, die sich in unterschiedlichem Maße überschneiden. Ein IAA, das sich in den ersten beiden Lebensjahrzehnten manifestiert, ist in den meisten Fällen idiopathisch. In mehr als 80 % aller Fälle sind IAA bei Kindern und Jugendlichen idiopathisch, traumatisch (zweithäufigste Ursache) oder durch hämodynamische Überlastung (dritthäufigste Ursache) bedingt. Die meisten der verbleibenden Fälle gehen auf angeborene aneurysmatische Erkrankungen der Hirngefäße und auf Infektionen zurück. Multiple IAA kommen bei Kleinkindern selten vor, außer bei Kindern mit erworbener (infolge geschwächter Immunlage) oder angeborener aneurysmatischer zerebraler Arteriopathie oder einer Infektion als Ursache des IAA.

Abstract

Intracranial arterial aneurysms (IAAs) are rare in children. Nevertheless, IAAs account for at least 10 % – 15 % of hemorrhagic strokes during the first two decades of life. Traditional vascular risk factors, which are common in the adult population, are generally absent in the pediatric population, engendering distinct modes of IAA pathogenesis. Classification of pediatric IAAs according to the pathogenetic mechanism shows eight distinct categories: idiopathic, traumatic, those due to excessive hemodynamic stress, vasculopathic, infectious, noninfectious inflammatory, oncotic, and familial. Pathogenetic mechanism is the best predictor of the clinical course of the disease, response to treatment, and long-term prognosis. The pathogenetic subtypes of pediatric IAA show characteristic and variably overlapping features. In most cases, IAAs manifesting during the first two decades of life are idiopathic. IAAs that are idiopathic, traumatic (second most common type), or due to excessive hemodynamic stresses (third most common type) account for more than 80 % of IAAs in the pediatric age group. Most of the remaining pediatric IAAs are the result of congenital cerebral aneurysmal arteriopathies or infection. Multiple IAAs are unusual in young children except in those with acquired (secondary to immune deficiency states) or congenital cerebral aneurysmal arteriopathies or infectious IAAs.

¹ © 2012 The Radiological Society of North America. All rights reserved. Originally puplished in English in RadioGraphics 2012; 32: 667 – 681. Online published in 10.1148 /rg.323105224. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.

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