Skip to main content
SpringerLink
Log in

Differenzialdiagnostisch relevante Untersuchungsbefund bei Enzephalopathien

  • Chapter
  • First Online:
Bewusstseinsstörungen und Enzephalopathien

  • 4378 Accesses

Zusammenfassung

Technische Zusatzbefunde von besonderer diagnostischer Relevanz für Enzephalopathien stammen aus neuroradiologischen Verfahren (CCT und MRT), aus der Neurophysiologie (EEG, evozierte Potentiale) und aus biochemischen Untersuchungen. Die Bildgebung gestattet insbesondere den Ausschluss andersartiger Ursachen der Symptomatik; sie kann in einigen Fällen aber auch die Enzephalopathie eingrenzen und fokale Schwerpunkte im Marklager oder den Basalganglien nachweisen, die der klinischen Untersuchung entgehen. Schwerpunkt der neurophysiologischen Diagnostik ist die funktionelle Überprüfung der Reizleitung und Reaktivität des Patienten auf Außenreize, woraus sich der Schweregrad bemessen lässt (z.B. Komatiefe). Biochemische Untersuchungen von Serum, Urin und Liquor sind aus der ätiologischen Differenzialdiagnose nicht wegzudenken. Von den genannten Methoden werden hier diagnostisch relevante Befunde präsentiert.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Literatur

  • Allmendinger AM, Tang ER, Lui YW, Spektor V (2012) Imaging of Stroke: Part 1, Perfusion CT – Overview of Imaging Technique, Interpretation Pearls, and Common Pitfalls. Am J Roentgenol 198: 52–62

    Article  Google Scholar 

  • Aly L, Yousef S, Schippling S, Jelcic I, Breiden P, Matschke J et al. (2011) Central role of JC virus-specific CD4+ lymphocytes in progressive multi-focal leucoencephalopathy-immune reconstitution inflammatory syndrome. Brain 134 (Pt 9): 2687–702

    Article  PubMed  Google Scholar 

  • Angel MJ, Young GB (2011) Metabolic encephalopathies. Neurol Clin 29(4): 837–82

    Article  PubMed  Google Scholar 

  • Arbelaez A, Castillo M, Mukherji SK (1999) Diffusion-weighted MR Imaging of Global Cerebral Anoxia. Am J Neuroradiol 20: 999–1007

    PubMed  CAS  Google Scholar 

  • Ashwal S, Babikian T, Gardner-Nichols J, Freier M-C, Tong KA, Holshouser BA (2006) Susceptibility-weighted imaging and proton magnetic resonance spectroscopy in assessment of outcome after pediatric traumatic brain injury. Arch Phys Med Rehabil 87, Suppl 2: S50–8

    Article  PubMed  Google Scholar 

  • Askar M, Faber MS, Frank C, Bernard H, Gilsdorf A, Fruth A et al. (2011) Update on the ongoing outbreak of haemolytic uraemic syndrome due to Shiga toxin-producing Escherichia coli (STEC) serotype O104, Germany, May 2011. Euro surveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 16(22). Epub 2011/06/15

    Google Scholar 

  • Barcena-Panero A, Echevarria JE, Romero-Gomez MP, Royuela E, Castellanos A, Gonzalez I et al. (2012) Development and validation with clinical samples of internally controlled multiplex real-time PCR for diagnosis of BKV and JCV infection in associated pathologies. Comp Immunol Microbiol Infect Dis 35(2): 173–9

    Article  PubMed  Google Scholar 

  • Bartynski WS (2008) Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. Am J Neuroradiol 29: 1043–9

    Article  PubMed  CAS  Google Scholar 

  • Bartynski WS (2008) Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. Am J Neuroradiol 29: 1036–42

    Article  PubMed  CAS  Google Scholar 

  • Black S, Gao FQ, Bilbao J (2009) Understanding white matter disease imaging-pathological correlations in vascular cognitive impairment. Stroke 40, Suppl 1: S48–S52

    Article  PubMed  Google Scholar 

  • Bouwes A, Binnekade JM, Kuiper MA et al. (2012) Prognosis of coma after therapeutic hypothermia: a prospective cohort study. Ann Neurol 71: 206–12

    Article  PubMed  Google Scholar 

  • Brenner RP, Schaul N (1990) Periodic EEG patterns: classification, clinical correlation, and pathophysiology. J Clin Neurophysiol 7: 249–67

    Article  PubMed  CAS  Google Scholar 

  • Buchner H, Claßen J, Haupt WF et al. (2002) Empfehlungen für die Ausbildung „Evozierte Potentiale“ – Mindestanforderungen für die Durchführung. Klin Neurophysiol 33: 223–9

    Article  Google Scholar 

  • Buchner H, Gobbelé R (2012) Elektroenzephalographie, evozierte Potentiale, Neurografie und Elektromyografie. In: Schwab S, Schellinger P, Werner C, Unterberg A, Hacke W (Hrsg) Neurointensiv, 2. Aufl. Springer, Berlin Heidelberg New York

    Google Scholar 

  • Ciecko-Michalska I, Wojcik J, Wyczesany M, Binder M, Szewczyk J, Senderecka M, Dziedzic T, Slowik A, Mach T (2012) Cognitive evoked response potentials in patients with liver cirrhosis without diagnosis of minimal or overt hepatic encephalopathy. A pilot study. J Physiol Pharmacol 63(3): 271–6

    PubMed  CAS  Google Scholar 

  • De Feo P, Gallai V, Mazzotta G, Crispino G, Torlone E, Perriello G, Ventura MM, Santeusanio F, Brunetti P, Bolli GB (1988) Modest decrements in plasma glucose concentration cause early impairment in cognitive function and later activation of glucose counterregulation in the absence of hypoglycemic symptoms in normal man. J Clin Invest 82(2): 436–44

    Article  PubMed  CAS  Google Scholar 

  • Descamps M, Hyare H, Zerizer I, Ger HJA (2008) Neuroimaging of CNS involvement in HIV. J HIV Therapy 13: 48–54

    Google Scholar 

  • Ferbert A, Buchner H, Brückmann H, Zeumer H, Hacke W (1988) Evoked potentials in basilar artery thrombosis: correlation with clinical and angiographic findings. Electroencephalogr Clin Neurophysiol 69(2): 136–47

    Article  PubMed  CAS  Google Scholar 

  • Ferbert A, Buchner H, Brückmann H (1990) Brainstem auditory evoked potentials and somatosensory evoked potentials in pontine haemorrhage. Correlations with clinical and CT findings. Brain 113 (Pt 1): 49–63

    Article  PubMed  Google Scholar 

  • Ferracci F, Bertiato G, Moretto G (2004) Hashimoto’s encephalopathy: epidemiologic data and pathogenetic considerations. J Neurol Sci 217(2): 165–8

    Article  PubMed  Google Scholar 

  • Fugate JE, Wijdicks EF White RD et al. (2011) Does therapeutic hypothermia affect time to awakening in cardiac arrest? Neurology 77: 1346–50

    Article  PubMed  Google Scholar 

  • Gao B, Liu FL, Zhao B (2012) Association of degree and type of edema in posterior reversible encephalopathy syndrome with serum lactate dehydrogenase level: initial experience. Eur J Radiology 81(10): 2844–7

    Article  Google Scholar 

  • Grueter BE, Schulz UG (2012) Age-related cerebral white matter disease (leukoaraiosis): a review. Postgraduate Medical Journal 88: 79–87

    Article  PubMed  Google Scholar 

  • Guillaume B, Sindic CJ, Weber T (2000) Progressive multifocal leukoencephalopathy: simultaneous detection of JCV DNA and anti-JCV antibodies in the cerebrospinal fluid. Eur J Neurol 7(1): 101–6

    Article  PubMed  CAS  Google Scholar 

  • Guleria S, Kelly TG, Baruah D, Maheshwari M, Segall HD (2007) Neuroimaging findings in toxic brain injuries. Neurographics 2: 64–76

    Article  Google Scholar 

  • Hansen HC (2011) Sooner or later…? In search of the most useful components of the somatosensory evoked potential to define prognosis in critically ill patients with acute stroke. Clin Neurophysiol 122(8): 1482–4

    Google Scholar 

  • Hansen HC, Zschocke S, Stürenburg HJ, Kunze K (1998) Clinical changes and EEG patterns preceding the onset of periodic sharp wave complexes in Creutzfeldt-Jakob disease. Acta Neurol Scand 97: 99–106

    Article  PubMed  CAS  Google Scholar 

  • Haupt WF, Birkmann C, Halber M (2000) Serial evoked potentials and outcome in cerebrovascular disease. J Clin Neurophysiol 17: 326–30

    Article  PubMed  CAS  Google Scholar 

  • Haupt WF, Pawlik G, Thiel A (2006) Initial and serial evoked potentials in cerebrovascular critical care patients. J Clin Neurophysiol 23: 389–94

    Article  PubMed  Google Scholar 

  • Hedge AH, Mohan S, Lath N, Lim TCC (2011) Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. RadioGraphics 31: 5–30

    Article  Google Scholar 

  • Jacobi C, Lange P, Reiber H (2007) Quantitation of intrathecal antibodies in cerebrospinal fluid of subacute sclerosing panencephalitis, herpes simplex encephalitis and multiple sclerosis: discrimination between microorganism-driven and polyspecific immune response. J Neuroimmunol 187(1–2): 139–46

    Article  PubMed  CAS  Google Scholar 

  • Kanekar SG, Zacharia T, Roller R (2012) Imaging of stroke: Part 2, Pathophysiology at the molecular and cellular levels and corresponding imaging changes. Am J Roentgenology 198: 63–74

    Article  Google Scholar 

  • Kaplan PW (2004) The EEG in metabolic encephalopathy and coma (Review). J Clin Neurophysiol 21: 307–18

    Article  PubMed  Google Scholar 

  • Kirkpatrick MP, Clarke CD, Sonmezturk HH, Abou-Khalil B (2011) Rhythmic delta activity represents a form of nonconvulsive status epilepticus in anti-NMDA receptor antibody encephalitis. Epilepsy Behav 20(2): 392–4

    Article  PubMed  Google Scholar 

  • Knudsen TB, Larsen K, Kristiansen TB, Moller HJ, Tvede M, Eugen-Olsen J et al. (2007) Diagnostic value of soluble CD163 serum levels in patients suspected of meningitis: comparison with CRP and procalcitonin. Scand J Infect Dis 39(6–7): 542–53

    Article  PubMed  CAS  Google Scholar 

  • Kracker S, Radbruch A (2004) Immunoglobulin class switching: in vitro induction and analysis. Methods Mol Biol 271: 149–59

    PubMed  CAS  Google Scholar 

  • Kullmann F, Hollerbach S, Holstege A, Schölmerich J (1995) Subclinical hepatic encephalopathy: diagnostic value of evoked potentials. J Hepatol 22: 101–10

    Article  PubMed  CAS  Google Scholar 

  • Kuroiwa Y, Celesia GC (1980) Clinical significance of periodic EEG Patterns. Arch Neurol 37: 15–20

    Article  PubMed  CAS  Google Scholar 

  • Lejon V, Reiber H, Legros D, Dje N, Magnus E, Wouters I et al. (2003) Intrathecal immune response pattern for improved diagnosis of central nervous system involvement in trypanosomiasis. J Infect Dis 187(9): 1475–83

    Article  PubMed  Google Scholar 

  • Marx JJ, Mika-Gruettner A, Thoemke F, Fitzek S, Fitzek C, Vucurevic G, Urban PP, Stoeter P, Hopf HC (2002) Electrophysiological brainstem testing in the diagnosis of reversible brainstem ischemia. J Neurol 249(8): 1041–7

    Article  PubMed  Google Scholar 

  • Montagnese S, Biancardi A, Schiff S, Carraro P, Carla V, Mannaioni G et al. (2001) Different biochemical correlates for different neuropsychiatric abnormalities in patients with cirrhosis. Hepatology 53(2): 558–66

    Article  Google Scholar 

  • Niedermeyer E, Sherman DL, Geocadin RJ, Hansen HC, Hanley DF (1999) The Burst-Suppression Electroencephalogram. Clinical Electroencephalography 30: 99–105

    PubMed  CAS  Google Scholar 

  • Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M et al. (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurology 69: 292–302

    Article  Google Scholar 

  • Reiber H (2002) Proteindiagnostik. In: Zettl U, Lehmitz R, Mix E (Hrsg) Klinische Liquordiagnostik, S 177–246. de Gruyter, Berlin

    Google Scholar 

  • Reiber H (2003) Proteins in cerebrospinal fluid and blood: barriers, CSF flow rate and source-related dynamics. Restor Neurol Neurosci 21(3–4): 79–96

    PubMed  CAS  Google Scholar 

  • Rovira A, Alonso J, Córdoba J (2008) MR imaging findings in hepatic encephalopathy. Am J Neuroradiology 29: 1612–21

    Article  CAS  Google Scholar 

  • Ruedinger JM, Nickel CH, Maile S, Bodmer M, Kressig RW, Bingisser R (2012) Diuretic use, RAAS blockade and morbidity in elderly patients presenting to the Emergency Department with non-specific complaints. Swiss Medical Weekly 142: w13568

    Google Scholar 

  • Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D (2012) Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology 79(11): 1094–100

    Article  PubMed  Google Scholar 

  • Schwab S, Schellinger P, Werner C, Unterberg A, Hacke W (2012) NeuroIntensiv, 2. Aufl. Springer, Berlin Heidelberg New York

    Book  Google Scholar 

  • Shimizu M, Kuroda M, Sakashita N, Konishi M, Kaneda H, Igarashi N et al. (2012) Cytokine profiles of patients with enterohemorrhagic Escherichia coli O111-induced hemolytic-uremic syndrome. Cytokine 60(3): 694–700

    Article  PubMed  CAS  Google Scholar 

  • Stöhr M, Riffel B, Pfadenhauer K (1991) Neurophysiologische Untersuchungsmethoden in der Intensivmedizin. Springer, Berlin Heidelberg New York

    Book  Google Scholar 

  • Stromillo ML, Dotti MT, Battaglini M, Mortilla M, Bianchi S, Plewnia K, Pantoni L et al. (2009) Structural and metabolic brain abnormalities in preclinical cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy. J Neurology Neurosurg Psychiatry 80: 41–7

    Article  CAS  Google Scholar 

  • Tschampa HJ, Kallenberg K, Kretzschmar HA, Meissner B, Knauth M, Urbach H, Zerr I (2007) Pattern of cortical changes in sporadic Creutzfeldt-Jakob disease. Am J Neuroradiol 28(6): 1114–8

    Article  PubMed  CAS  Google Scholar 

  • Van Dijk JM, Willinsky RA (2003) Venous congestive encephalopathy related to cranial duralarteriovenous fistulas. Neuroimaging Clinics of North America 13: 55–72

    Article  PubMed  Google Scholar 

  • Wandinger KP, Saschenbrecker S, Stoecker W, Dalmau J (2011) Anti-NMDA-receptor encephalitis: a severe, multistage, treatable disorder presenting with psychosis. Journal Neuroimmunology 231(1–2): 86–91

    Article  CAS  Google Scholar 

  • Weaver LK (2009) Clinical practice. Carbon monoxide poisoning. N Engl J Med 360(12): 1217–25

    Article  PubMed  CAS  Google Scholar 

  • Weber T. Progressive multifocal leukoencephalopathy. Neurol Clin. 2008;26(3):833–54.

    Article  PubMed  Google Scholar 

  • Weber T, Trebst C, Frye S, Cinque P, Vago L, Sindic CJ et al. (1997a) Analysis of the systemic and intrathecal humoral immune response in progressive multifocal leukoencephalopathy. J Infect Dis 176(1): 250–4

    Article  CAS  Google Scholar 

  • Weber T, Otto M, Bodemer M, Zerr I (1997b) Diagnosis of Creutzfeldt-Jakob disease and related human spongiform encephalopathies. Biomedicine & Pharmacotherapy 51(9): 381–7

    Article  CAS  Google Scholar 

  • Zandbergen EG, de Haan RJ, Hijdra A (2001) Systematic review of prediction of poor outcome in anoxic-ischaemic coma with biochemical markers of brain damage. Intensive Care Med 27(10): 1661–7

    Article  PubMed  CAS  Google Scholar 

  • Zandbergen EG, Hijdra A, Koelman JH et al. (2006) Prediction of poor outcome within the first 3 days of postanoxic coma. Neurology 66: 62–8

    Article  PubMed  CAS  Google Scholar 

  • Zauner C, Gendo A, Kramer L, Funk GC, Bauer E, Schenk P, Ratheiser K, Madl C (2002) Impaired subcortical and cortical sensory evoked potential pathways in septic patients. Crit Care Med 30(5): 1136–9

    Article  PubMed  Google Scholar 

  • Zauner C, Gendo A, Kramer L, Kranz A, Grimm G, Madl C (2000) Metabolic encephalopathy in critically ill patients suffering from septic or nonseptic multiple organ failure. Crit Care Med 28(5): 1310–5

    Article  PubMed  CAS  Google Scholar 

  • Zschocke S, Hansen HC (2012) Klinische Elektroenzephalographie, 3. Aufl. Springer, Berlin Heidelberg New York

    Book  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus KielArnold-Heller-Straße, 324105, Kiel, Deutschland

    O. Jansen & C. Cnyrim

  2. Universitätskrankenhaus Hamburg-Eppendorf, Altonaer Straße 348, a25469, Halstenbek, Deutschland

    S. Zschocke

  3. Klinik für Neurologie und Psychiatrie, Friedrich-Ebert-Krankenhaus GmbH Neumünster, Friesenstr. 11, 24534, Neumünster, Deutschland

    H.-C. Hansen

  4. Klinik und Poliklinik für Neurologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    W. Haupt

  5. Neurologische Klinik, Kath. Marienkrankenhaus gGmbH, Alfredstraße 9, 22087, Hamburg, Deutschland

    T. Weber

Authors
  1. O. Jansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Cnyrim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Zschocke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H.-C. Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Haupt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T. Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Klinik für Neurologie und Psychiatrie, Friedrich-Ebert-Krankenhaus Neumünster GmbH, Neumünster, Germany

    Hans-Christian Hansen

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Jansen, O., Cnyrim, C., Zschocke, S., Hansen, HC., Haupt, W., Weber, T. (2013). Differenzialdiagnostisch relevante Untersuchungsbefund bei Enzephalopathien. In: Hansen, HC. (eds) Bewusstseinsstörungen und Enzephalopathien. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36915-5_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-36915-5_9

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-36914-8

  • Online ISBN: 978-3-642-36915-5

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation