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Nervenheilkunde 2014; 33(07/08): 499-504
DOI: 10.1055/s-0038-1627707
Fortbildung Karlsruhe
Schattauer GmbH

Kindlicher Schlaganfall

Ein seltenes Ereignis, das rasch erkannt sein willArterial ischaemic childhood stroke: a clinical approach to increase awareness
A. Lustenberge
1   Abteilung für Neuropädiatrie, Med. Universitätskinderklinik Inselspital, Bern, Schweiz
,
M. Steinlin
1   Abteilung für Neuropädiatrie, Med. Universitätskinderklinik Inselspital, Bern, Schweiz
› Author Affiliations
Further Information

Publication History

eingegangen am: 02 February 2014

angenommen am:: 03 March 2014

Publication Date:
24 January 2018 (online)

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Zusammenfassung

Im Gegensatz zu Erwachsenen ist der Schlaganfall bei Kindern ein seltenes Ereignis mit weitreichenden Konsequenzen, nicht nur für das Kind und dessen Familie, sondern aufgrund hoher Folgekosten auch für das Gesundheitswesen. Wegen der Seltenheit und mannigfaltigen Klinik wird die Diagnose oft deutlich verzögert gestellt. Die Hemiparese (mit/ohne Dysphasie oder Fazialisparese) ist bei 70% bis 80% der betroffenen Kinder das Leitsymptom; Kopfschmerzen, Krampfanfälle und Bewusstseinsstörungen sind weitere Symptome. Goldstandard zur Bestätigung der Verdachtsdiagnose ist die diffusionsgewichtete Magnetresonanztomografie. Als wichtigste Risikofaktoren sind Infektionen, kardiale Ursachen sowie Vaskulound Koagulopathien zu nennen. Abhängig vom Vorliegen der einzelnen Risikofaktoren beträgt das Rezidivrisiko 14% bis 19%. Bei zwei Dritteln der Fälle bleiben neurologische Residualsymptome zurück. Das optimale therapeutische Vorgehen wird kontrovers diskutiert. Plättchenaggregationshemmer und Heparinisierung werden gleichwertig eingesetzt. Die Thrombolyse stellt eine mögliche Alternative dar, deren Indikation jedoch bei fehlender Evidenz im Kindesalter sorgfältig gestellt werden muss. Das frühe Erkennen eines zerebrovaskulären Insults beim Kind ist entscheidend für die therapeutischen Optionen und das Langzeitergebnis.

Summary

Childhood stroke is a rare event with an important burden not only for affected children and families but also because of its socioeconomic consequences. Diagnosis is often delayed due to its variety of different clinical symptoms. The most important is hemiparesis (with/without dysphasia or facial palsy), but headache, seizures or alteration of consciousness are also seen. Magnetic resonance imaging (diffusion weighted) is the gold standard to confirm arterial ischaemic childhood stroke. The presence of risk factors such as infections, cardiac problems, arteriopathies or hereditary coagulopathies increases the probability of a stroke. Residual problems, of which neurologic, cognitive or behavioural problems are the most important, can be found in about two-thirds out of the affected children. The best treatment is still a subject of controversial discussion. Whereas platelet antiaggregation and heparinization are used equally, indication for thrombolysis must be evaluated carefully. Accurate diagnosis of an arterial ischaemic stroke as early as possible will determine both, therapeutic options and neurodevelopmental outcome.

Schlüsselwörter

Kindlicher ischämischer Schlaganfall - Symptome - Risikofaktoren - Therapie - entwicklungsneurologisches Langzeitergebnis

Keywords

Childhood stroke manifestation - risk factors - treatment - outcome
 

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