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Aktuelle Probleme der Diagnose und Therapie zerebraler Venen- und duraler Sinusthrombosen

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Zusammenfassung

Neue radiologische Methoden und klinische Studien haben die Diagnostik und Therapie der Sinusthrombose entscheidend verändert. Die Sinusthrombose gilt heute als Erkrankung mit guter Prognose. Die Mortalität liegt unter 10%, und die überwiegende Mehrzahl der Patienten erholt sich ohne Residuen. Die Akutbehandlung mit Heparin hat sich allgemein durchgesetzt, obwohl die Effektivität dieser Therapie nicht überzeugend bewiesen ist. Über den Nutzen einer längerfristigen Antikoagulation gibt es keine gesicherten Erkenntnisse. Bei Vorliegen eines Hyperkoagulabilitätssyndroms wird eine Antikoagulation über 6 Monate empfohlen. APC-Resistenz, Hyperhomocysteinämie und die Prothrombinmutation G20210A wurden in den letzten Jahren als Risikofaktoren etabliert. Fraglich bleibt, ob eine längerfristige Antikoagulation auch bei idiopathischer Sinusthrombose sinnvoll ist. Die konventionelle Angiographie wird heute nur noch selten eingesetzt, da mit der MRT inklusive MR-Venographie und der CT-Venographie nichtinvasive Verfahren mit hoher Zuverlässigkeit verfügbar sind. Systemische und lokale Fibrinolyse sowie interventionelle rekanalisierende Verfahren können nicht allgemein empfohlen werden.

Summary

Over the last few years, the results from clinical studies and innovative radiological approaches have significantly altered the management of patients with cerebral venous thrombosis. In contrast to previously held beliefs, cerebral venous thrombosis is considered to be a relatively benign disease with an overall favourable prognosis. Mortality is <10%, and the vast majority of patients recover completely. Although the efficacy of heparin has not been unequivocally proven, it is employed in most centres as the standard therapy. There are not sufficient data supporting long-term anticoagulation. In patients with a proven hypercoagulability syndrome, anticoagulation therapy is generally recommended for a period of 6 months. Whether patients with idiopathic thrombosis should also be treated remains controversial. Non-invasive MR and CT angiography techniques have largely replaced conventional angiography for initial evaluation and follow-up examinations. Both methods have a high sensitivity for cerebral venous thrombosis. Local fibrinolytic therapy or other aggressive recanalizing methods can not be generally recommended.

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Authors and Affiliations

  1. Neurologische Universitätsklinik, Klinikum Mannheim, Mannheim

    S. Schwarz, M. Daffertshofer & M. Hennerici

  2. Abteilung Angiologie, Medizinische Universitätsklinik, Dresden

    T. Schwarz

  3. Neurologische Klinik, Universitätsspital Zürich, Zürich, Schweiz

    D. Georgiadis & R. W. Baumgartner

  4. Abteilung Neuroradiologie, Klinikum Mannheim, Mannheim

    C. Groden

  5. Neurologische Universitätsklinik, Klinikum Mannheim, Theodor-Kutzer-Ufer 1–3, 68135 , Mannheim

    S. Schwarz

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Schwarz, S., Daffertshofer, M., Schwarz, T. et al. Aktuelle Probleme der Diagnose und Therapie zerebraler Venen- und duraler Sinusthrombosen. Nervenarzt 74, 639–653 (2003). https://doi.org/10.1007/s00115-003-1526-1

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