Skip to main content
SpringerLink
Log in

Bildgebende Diagnostik beim Hirnstamminfarkt

Imaging techniques in diagnosis of brainstem infarction

  • CME Weiterbildung · Zertifizierte Fortbildung
  • Published:
Der Nervenarzt Aims and scope Submit manuscript

Zusammenfassung

Etwa 20% aller ischämischen Infarkte betreffen das vertebrobasiläre Stromgebiet. Anhand der aktuellen Literatur und eigener Erfahrungen wird die Wertigkeit bildgebender Verfahren zur Erkennung einer parenchymalen Läsion im Hirnstamm dargestellt. Dabei wird auf neuere Entwicklungen auf dem Gebiet der Computertomographie (CT) und Magnetresonanztomographie (MRT) eingegangen. Darüber hinaus werden die verschiedenen invasiven (intraarterielle Angiographie) und non- bzw. semiinvasiven Methoden (MRA, CTA, Ultraschall) zum Nachweis stenookklusiver Prozesse im vertebrobasilären Stromgebiet und ihre Indikationen beim akuten Hirnstamminfarkt vorgestellt. Das diagnostische Prozedere bei der schwersten Form des Hirnstamminfarktes, der Basilaristhrombose, wird skizziert.

Summary

Twenty per cent of cerebral ischaemic infarctions involve tissue, supplied by the vertebrobasilar circulation. This overview of the current literature and our own experiences present the value of different imaging techniques (CT and MRI) and new developments for diagnosing brainstem infarction. Furthermore, the roles of invasive and noninvasive vascular imaging methods (computed tomographic angiography, magnetic resonance angiography, intra-arterial angiography, ultrasound) for evaluating vertebrobasilar stenosis and occlusion are described. The diagnostic workup of the most severe form of brainstem infarction, basilar artery thrombosis, is shown.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8

Literatur

  1. Amarenco P (1991) The spectrum of cerebellar infarctions. Neurology 41: 973–979

    PubMed  Google Scholar 

  2. de Bray JM, Missoum A, Dubas F et al. (1997) Detection of vertebrobasilar intracranial stenoses: transcranial Doppler sonography versus angiography. J Ultrasound Med 3: 213–218

    Google Scholar 

  3. Butz B, Dorenbeck U, Borisch I et al. (2004) High-resolution contrast-enhanced magnetic resonance angiography of the carotid arteries using fluoroscopic monitoring of contrast arrival: diagnostic accuracy and interobserver variability. Acta Radiol 45: 164–170

    Article  PubMed  Google Scholar 

  4. Caplan LR, Biousse V (2004) Cervicocranial arterial dissections. J Neuroophthalmol 24: 299–305

    PubMed  Google Scholar 

  5. Caplan LR, Wityk RJ, Glass TA et al. (2004) New England Medical Center Posterior Circulation Registry. Ann Neurol 56: 389–398

    Article  PubMed  Google Scholar 

  6. Dittrich R, Dziewas R, Ritter MA et al. (2006) Negative ultrasound findings in patients with cervical artery dissection: Negative ultrasound in CAD. J Neurol 253: 424–433

    Article  PubMed  Google Scholar 

  7. Droste DW, Nabavi DG, Kemeny V et al. (1998) Echocontrast enhanced transcranial colour-coded duplex offers improved visualization of the vertebrobasilar system. Acta Neurol Scand 98: 193–199

    PubMed  Google Scholar 

  8. Duvernoy A (1978) The human brainstem vessels. Springer, Berlin Heidelberg New York

  9. Eckert B, Kucinski T, Pfeiffer G et al. (2002) Endovascular therapy of acute vertebrobasilar occlusion: early treatment onset as the most important factor. Cerebrovasc Dis 14: 42–50

    Article  PubMed  Google Scholar 

  10. Ersoy H, Watts R, Sanelli P et al. (2003) Atherosclerotic disease distribution in carotid and vertebrobasilar arteries: clinical experience in 100 patients undergoing fluoro-triggered 3D Gd-MRA. J Magn Reson Imaging 17: 545–558

    Article  PubMed  Google Scholar 

  11. Etgen T, Gräfin von Einsiedel H, Rottinger M et al. (2004) Detection of acute brainstem infarction by using DWI/MRI. Eur Neurol 52: 145–150

    Article  PubMed  Google Scholar 

  12. Fitzek S, Fitzek C, Marx J et al. (2003) Läsionsverteilung von Hirnstamminfarkten im MRT. Klin Neuroradiol 13: 203–207

    Article  Google Scholar 

  13. Glass TA, Hennessey PM, Pazdera L et al. (2002) Outcome at 30 days in the New England Medical Center Posterior Circulation Registry. Arch Neurol 59: 369–376

    Article  PubMed  Google Scholar 

  14. Hacke W, Zeumer H, Ferbert A et al. (1988) Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 19: 1216–1222

    Google Scholar 

  15. Kidwell CS, Alger JR, Di Salle F et al. (1999) Diffusion MRI in patients with transient ischemic attacks. Stroke 30: 1174–1180

    PubMed  Google Scholar 

  16. Koga M, Kimura K, Minematsu K et al. (2002) Relationship between findings of conventional and contrast-enhanced transcranial color-coded real-time sonography and angiography in patients with basilar artery occlusion. AJNR Am J Neuroradiol 23: 568–571

    PubMed  Google Scholar 

  17. Krasnianski M, Lindner A, Zierz S (2002) Brainstem infarctions with normal MRI. Eur J Med Res 7: 125–127

    PubMed  Google Scholar 

  18. Küker W, Weise J, Krapf H et al. (2002) MRI characteristics of acute and subacute brainstem and thalamic infarctions: value of T2- and diffusion-weighted sequences. J Neurol 249: 33–42

    Article  PubMed  Google Scholar 

  19. Labauge R, Pages M, Blard JM (1981) Survie prolongee apres occlusion du tronc basilaire. Rev Neurol 145: 789–794

    Google Scholar 

  20. Lamy C, Oppenheim C, Clavet D et al. (2006) Diffusion-weighted MR imaging in transient ischaemic attacks. Eur Radiol 16: 1090–1095

    Article  PubMed  Google Scholar 

  21. Lövblad KO, Laubach HJ, Baird AE et al. (1998) Clinical experience with diffusion-weighted MR in patients with acute stroke. AJNR Am J Neuroradiol 19: 1061–1066

    PubMed  Google Scholar 

  22. Marx JJ, Mika-Gruettner A, Thoemke F et al. (2002) Electrophysiological brainstem testing in the diagnosis of reversible brainstem ischemia. J Neurol 249: 1041–1047

    Article  PubMed  Google Scholar 

  23. Marx JJ, Mika-Gruettner A, Thoemke F et al. (2002) Diffusion weighted magnetic resonance imaging in the diagnosis of reversible ischaemic deficits of the brainstem. J Neurol Neurosurg Psychiatry 72: 572–575

    Article  PubMed  Google Scholar 

  24. Marx JJ, Thoemke F, Mika-Gruettner A et al. (2004) Diffusionsgewichtetes MRT bei vertebrobasilären Ischämien. Nervenarzt 75: 341–346

    Article  PubMed  Google Scholar 

  25. Oppenheim C, Stanescu R, Dormont D et al. (2000) False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol 21: 1434–1440

    PubMed  Google Scholar 

  26. Pfefferkorn T, Mayer TE, Schulte-Altedorneburg G et al. (2006) Diagnostik und Therapie der Basilaristhrombose. Nervenarzt 77: 416–422

    Article  PubMed  Google Scholar 

  27. Ries S, Steinke W, Devuyst G et al. (1998) Power Doppler imaging and color Doppler flow imaging for the evaluation of normal and pathological vertebral arteries. J Neuroimaging 8: 71–74

    PubMed  Google Scholar 

  28. Ringelstein EB, Weiller C (1990) Pattern of cerebral infarct in computerized tomography. Pathophysiologic concepts, validation and clinical relevance. Nervenarzt 61: 462–471

    PubMed  Google Scholar 

  29. Savitz SI, Caplan LR (2005) Vertebrobasilar disease. N Engl J Med 352: 2618–2626

    Article  PubMed  Google Scholar 

  30. Schievink WI, Mokri B, O’Fallon WM (1994) Recurrent spontaneous cervical artery dissection. N Engl J Med 330: 393–397

    Article  PubMed  Google Scholar 

  31. Schramm P (2005) CT-Diagnostik bei akuter zerebraler Ischämie. Radiologe 45: 420–429

    Article  PubMed  Google Scholar 

  32. Schulte-Altedorneburg G, Csiba L (1999) Die Ultraschalldiagnostik der extrakraniellen hirnversorgenden Arterien. Klin Neurophysiol 30: 248–262

    Google Scholar 

  33. Schulte-Altedorneburg G, Mayer TE (2004) Hirnstamminsult: Bildgebende Diagnostik und endovaskuläre Therapiekonzepte. Radiologieup2date 3: 213–235

    Google Scholar 

  34. Schulte-Altedorneburg G, Droste DW, Popa V et al. (2000) Visualization of the basilar artery by transcranial color-coded duplex sonography. Stroke 31: 1123–1127

    PubMed  Google Scholar 

  35. Schulte-Altedorneburg G, Hamann GF, Mull M et al. (2006) Outcome of acute vertebrobasilar occlusions treated with intra-arterial fibrinolysis in 180 cases. AJNR Am J Neuroradiol (im Druck)

  36. Schumacher M, Roßberg C, Brückmann H (1994) Neuroradiologische Diagnostik bei Hirnstamm- und Kleinhirninfarkten. Nervenheilkunde 13: 43–51

    Google Scholar 

  37. Stolz E, Nuckel M, Mendes I et al. (2002) Vertebrobasilar transcranial color-coded duplex ultrasonography: improvement with echo enhancement. AJNR Am J Neuroradiol 23: 1051–1054

    PubMed  Google Scholar 

  38. Sturzenegger M, Mattle HP, Rivoir A et al. (1993) Ultrasound findings in spontaneous extracranial vertebral artery dissection. Stroke 24: 1910–1921

    PubMed  Google Scholar 

  39. Toi H, Uno M, Harada M et al. (2003) Diagnosis of acute brain-stem infarcts using diffusion-weighed MRI. Neuroradiology 45: 352–356

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland

    G. Schulte-Altedorneburg

  2. Abteilung für Neuroradiologie, LMU München, Klinikum Großhadern

    G. Schulte-Altedorneburg & H. Brückmann

Authors
  1. G. Schulte-Altedorneburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Brückmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Schulte-Altedorneburg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schulte-Altedorneburg, G., Brückmann, H. Bildgebende Diagnostik beim Hirnstamminfarkt. Nervenarzt 77, 731–744 (2006). https://doi.org/10.1007/s00115-006-2091-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00115-006-2091-1

Schlüsselwörter

Keywords

Search

Navigation