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| == Diagnostik ==
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| === Diagnosekriterien ===
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| <span class="toctext"><span style="color: black">Der kulturelle Nachweis von Kryptokokken stellt den Goldstandard für die Diagnose einer Kryptokokkose dar und sollte somit bei Verdacht auf eine Kryptokokkose immer durchgeführt werden. Auf Sabouraud-Agar kann man in der Regel Kryptokokken innerhalb von 3 Tagen nachweisen, bei sehr geringer Erregerlast kann die kulturelle Anzucht jedoch bis zu 14 Tagen dauern. Das Kryptokokkenantigen (CrAg) aus dem Serum hat sich aufgrund seiner exzellenten Sensitivität und Spezifität sowie seiner einfachen Handhabung (ELISA/Lateral-flow Assay) als Screeningtest für die Kryptokokkose in der Routinediagnostik etabliert. Ergänzend hierzu kann ein Tuschepräparat aus Liquor zur Mikroskopie durchgeführt werden. </span></span>
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| === Diagnostische Schritte ===
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| {| class="wikitable bs-exportable MsoTableGrid" border="1" cellspacing="0" cellpadding="0" width="671" style="width:503.0pt;border-collapse:collapse;border:none;mso-border-alt:solid windowtext .5pt;
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| mso-yfti-tbllook:1184;mso-padding-alt:0cm 5.4pt 0cm 5.4pt"
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:113.25pt;" width="151" valign="top" | <span style="font-size:11.0pt">'''Maßnahme''' </span>
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:170.0pt;" width="227" valign="top" |<span style="font-size:11.0pt">'''Indikation''' </span>
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:219.75pt;" width="293" valign="top" |<span style="font-size:11.0pt">'''Kommentar''' </span>
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| |- style="mso-yfti-irow:1"
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:113.25pt;" width="151" valign="top" |<span style="font-size:11.0pt">Liquorpunktion (LP) <span style="mso-spacerun:yes"> </span></span>
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:170.0pt;" width="227" valign="top" |<span style="font-size:11.0pt">erforderlich in Abhängigkeit von Klinik und Diagnostik zur Abklärung einer Kryptokokken-meningitis (KM) </span>
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:219.75pt;" width="293" valign="top" |<span style="font-size:11.0pt">Eine LP sollte durchgeführt werden bei 1) ZNS- Symptomen 2) bei allen Patienten mit positivem Serum CrAg +/- positiver Fungämie (Blutkultur) +/- positiven Biopsien. Unabhängig vom Liquorbefund sollte immer eine CrAg-Bestimmung, ein Tuschepräparat und eine kulturelle Anzucht erfolgen, da eine Zellzahlerhöhung im Liquor bei entsprechender Immunsuppression auch fehlen kann<sup><span style="mso-no-proof:yes">13</span></sup>. Eine lymphozytäre Pleozytose mit einem erhöhten Eiweiß und einer erniedrigten Glukose ist ein typischer Liquorbefund einer KM.</span>
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| |- style="mso-yfti-irow:2"
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:113.25pt;" width="151" valign="top" |<span style="font-size:11.0pt">Kryptokokken-Antigen CrAg </span>
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:170.0pt;" width="227" valign="top" |<span style="font-size:11.0pt">immer erforderlich (Screeningtest) aus Serum bei schwerer Immunsuppression (HIV CD4 < 200/µl)<sup><span style="mso-no-proof:yes">14</span></sup></span>
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:219.75pt;" width="293" valign="top" |<span style="font-size:11.0pt">Das CrAg weist in der Regel eine sehr hohe Sensitivität und Spezifität auf. Ein negatives Serum CrAg schließt mit hoher Wahrscheinlichkeit eine Kryptokokken-infektion aus<sup><span style="mso-no-proof:yes">15</span></sup>. Die Höhe des Serum CrAg-Titers korreliert mit der Erregerlast /Erkrankungsschwere und der Wahrscheinlichkeit für eine ZNS-Infektion<sup><span style="mso-no-proof:yes">9</span></sup>. </span>
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| |- style="mso-yfti-irow:3"
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:113.25pt;" width="151" valign="top" |<span style="font-size:11.0pt">Kultur </span>
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:170.0pt;" width="227" valign="top" |<span style="font-size:11.0pt">immer erforderlich </span>
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:219.75pt;" width="293" valign="top" |<span style="font-size:11.0pt">Eine Kultur aus Blut/Liquor/Biopsie sollte immer durchgeführt werden (Goldstandard) </span>
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:113.25pt;" width="151" valign="top" |cMRT/cCT/CT-Thorax/Abdomen
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:170.0pt;" width="227" valign="top" |<span style="font-size:11.0pt">erforderlich in Abhängigkeit von Klinik und Diagnostik</span>
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:219.75pt;" width="293" valign="top" |<span style="font-size:11.0pt">Eine (cerebrale) Bildgebung sollte durchgeführt werden bei 1) (fokal) neurologischer Symptomatik 2) positivem Serum CrAg. Insbesondere bei einem positivem CrAg ohne Meningitisnachweis sollte eine komplette Bildgebung des Körpers durchgeführt werden, um Kryptokokkome auszuschließen<sup><span style="mso-no-proof:yes">15</span></sup>.</span>
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| |- style="mso-yfti-irow:5;mso-yfti-lastrow:yes"
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:113.25pt;" width="151" valign="top" |<span style="font-size:11.0pt">Bronchoalveoläre Lavage</span>'''<span style="color: #202124"> (</span>'''<span style="font-size:11.0pt">BAL) </span>
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:170.0pt;" width="227" valign="top" |<span style="font-size:11.0pt">ggf. erforderlich in Abhängigkeit von Klinik und Diagnostik</span>
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| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:219.75pt;" width="293" valign="top" |<span style="font-size:11.0pt">Bei Nachweis von Infiltraten sollte eine BAL mit einer kulturellen Anlage auf Kryptokokken durchgeführt werden. <span style="mso-spacerun:yes"> </span></span>
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| === Differentialdiagnosen ===
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| {| class="wikitable sortable bs-exportable MsoTableGrid" border="1" cellspacing="0" cellpadding="0" width="1108" style="border-collapse:collapse;mso-table-layout-alt:fixed;border:none;
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| 0cm 5.4pt 0cm 5.4pt"
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| |+<span class="toctext"><span style="color: black">Differentialdiagnose der cerebralen Kryptokokkose (Bildgebung und Liqorbefund), modifiziert nach Tan et al.<sup>16</sup></span></span>
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| | style="width:84.8pt;" width="113" valign="top" |<span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;mso-no-proof:yes">'''Differentialdiagnose'''</span></span>
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| | style="width:85.95pt;" width="115" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">'''Verdrängender Effekt'''</span></span></span>
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| | style="width:55.8pt;" width="74" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:
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| 10.5pt;font-family:"Arial",sans-serif;mso-no-proof:yes">'''CD4-Zell zahl (HIV)'''</span></span></span>
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| | style="width:99.25pt;" width="132" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">'''Anteil solitäre Läsionen'''</span> </span></span>
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| | style="width:3.0cm;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">'''Lokalisation'''</span></span></span>
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| | style="width:92.15pt;" width="123" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">'''Enhancement im cCT / cMRT'''</span></span></span>
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| | style="width:150.8pt;" width="201" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">'''Sonstige Merkmale<span style="color: #0060DF"> </span>'''</span></span></span>
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| | style="width:177.35pt;" width="236" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">'''Liquorbefund'''</span> </span></span>
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| |- style="height:87.15ptpx;"
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| | style="width:84.8pt;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">'''Toxoplasmose'''</span></span></span>
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| | style="width:85.95pt;" width="115" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">häufig</span> </span></span>
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| | style="width:55.8pt;" width="74" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span style="font-size:11.0pt">< 200/µl</span></span>
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| | style="width:99.25pt;" width="132" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">Häufig multiple Läsionen</span> </span></span>
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| | style="width:3.0cm;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">frontal, Basal- ganglien, parietal</span> </span></span>
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| | style="width:92.15pt;" width="123" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">häufig ringförmiges Enhancement</span> </span></span>
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| | style="width:150.8pt;" width="201" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">Durchmesser 1-2 cm <span style="mso-spacerun:yes"> </span> Zeit von Symptombeginn bis zur klinischen räsentation:Tage<span style="color: #0060DF"> </span>Eine negative Toxoplasmose-Serologie macht eine cerebrale Toxoplasmose unwahrscheinlich, jedoch kein Auschlusskriterium.<span style="color: #0060DF"> </span></span></span></span>
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| | style="width:177.35pt;" width="236" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">Zellpopulation:</span> <span style="font-size:
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| 10.5pt;font-family:"Arial",sans-serif;mso-no-proof:yes">normal bis lymphozytäre Pleozytose <span style="mso-spacerun:yes"> </span> Glucose: normal bis erniedrigt Protein: normal bis erhöht<span style="mso-spacerun:yes"> </span> Sonstiges: Toxoplasmose PCR aus dem Liquor – Sensitivität 50-80% und Spezifität 100%</span></span></span>
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| |- style="height:143.05ptpx;"
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| | style="width:84.8pt;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">'''PML'''</span> </span></span>
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| | style="width:85.95pt;" width="115" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">selten</span> </span></span>
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| | style="width:55.8pt;" width="74" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span style="font-size:11.0pt">< 100/µl, gelegentlich auch höher </span></span>
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| | style="width:99.25pt;" width="132" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">häufig solitär (50%)</span> </span></span>
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| | style="width:3.0cm;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">Subcortical weisse Substanz, Cerrebellum, Hirnstamm</span></span></span>
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| | style="width:92.15pt;" width="123" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">ca. 25% mit Enhancement (insbesondere bei IRIS)</span> </span></span>
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| | style="width:150.8pt;" width="201" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="color: black">(T2 Wichtung): Hyperintense Areale in der weissen Substanz (T1-Wichtung): Hypointense Läsionen mit Aussprachung der Kortikalis <span style="mso-spacerun:yes"> </span> </span><span style="font-size:
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| 10.5pt;font-family:"Arial",sans-serif;mso-no-proof:yes">Zeit von Symptombeginn bis zur klinischen Präsentation: Wochen bis Monate, selten akut mit dem Bild eines Apoplex</span></span></span>
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| | style="width:177.35pt;" width="236" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">Zellpopulation:</span> <span style="font-size:
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| 10.5pt;font-family:"Arial",sans-serif;mso-no-proof:yes">normal bis selten lymphozytäre Pleozytose <span style="mso-spacerun:yes"> </span> Glucose: normal <span style="mso-spacerun:yes"> </span> Protein: normal bis erhöht<span style="mso-spacerun:yes"> </span> Sonstiges: JC-PCR aus dem Liquor – Sensitivität 50-90% und Spezifität 90-100%</span></span></span>
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| |- style="height:107.0ptpx;"
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| | style="width:84.8pt;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">'''Lymphom'''</span> </span></span>
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| | style="width:85.95pt;" width="115" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">häufig</span> </span></span>
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| | style="width:55.8pt;" width="74" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span style="font-size:11.0pt">< 100/µl</span></span>
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| | style="width:99.25pt;" width="132" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">häufig solitär (50%)</span> </span></span>
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| | style="width:3.0cm;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">periventrikulär, frontal, Cerebellum, temporal</span></span></span>
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| | style="width:92.15pt;" width="123" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="color: black">häufig, heterogenes Enhancement</span></span></span>
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| | style="width:150.8pt;" width="201" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="color: black">In der Regel > 3cm Durchmesser <span style="mso-spacerun:yes"> </span> </span><span style="font-size:
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| 10.5pt;font-family:"Arial",sans-serif;mso-no-proof:yes">Zeit von Symptombeginn bis zur klinischen Präsentation: Wochen</span> </span></span>
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| | style="width:177.35pt;" width="236" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">Zellpopulation:</span> <span style="font-size:
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| 10.5pt;font-family:"Arial",sans-serif;mso-no-proof:yes">normal bis lymphozytäre Pleozytose, FACS-Analyse – Nachweis von monoklonalen Lymphozyten <span style="mso-spacerun:yes"> </span> Glucose: normal <span style="mso-spacerun:yes"> </span> Protein: normal bis erhöht<span style="mso-spacerun:yes"> </span> Sonstiges: EBV-PCR aus dem Liquor – Sensitivität 100% und Spezifität 50%.</span> </span></span>
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| |- style="height:23.6ptpx;"
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| | style="width:84.8pt;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">'''CMV'''</span> </span></span>
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| | style="width:85.95pt;" width="115" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">nein</span> </span></span>
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| | style="width:55.8pt;" width="74" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span style="font-size:11.0pt">< 50/µl</span></span>
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| | style="width:99.25pt;" width="132" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:
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| 10.5pt;font-family:"Arial",sans-serif;mso-no-proof:yes">-</span></span></span>
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| | style="width:3.0cm;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">periventrikulär</span> </span></span>
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| | style="width:92.15pt;" width="123" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="color: black">< 50 % periventrikuläres (meningeales) <span style="mso-spacerun:yes"> </span>Enhancement </span></span></span>
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| | style="width:150.8pt;" width="201" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="color: black">in > 50% der Fälle unauffälliges MRT <span style="mso-spacerun:yes"> </span></span><span style="font-size:
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| 10.5pt;font-family:"Arial",sans-serif;mso-no-proof:yes">Zeit von Symptombeginn bis zur klinischen Präsentation: Tage</span></span></span>
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| | style="width:177.35pt;" width="236" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">Zellpopulation:</span> <span style="font-size:
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| 10.5pt;font-family:"Arial",sans-serif;mso-no-proof:yes">normal, selten erhöhte Neutrophilenzahl <span style="mso-spacerun:yes"> </span> Glucose: normal <span style="mso-spacerun:yes"> </span> Protein: normal bis erhöht<span style="mso-spacerun:yes"> </span> Sonstiges: CMV-PCR aus dem Liquor – Sensitivität > 90% und Spezifität >90%</span></span></span>
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| |- style="height:52.05ptpx;"
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| | style="width:84.8pt;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">'''Kryptokokkose'''</span></span></span>
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| | style="width:85.95pt;" width="115" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
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| mso-no-proof:yes">kommunizierender Hydrocephalus durch erhöhten intrakranialer Druck</span> </span></span>
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| | style="width:55.8pt;" width="74" valign="top" | <span style="mso-bookmark:_Hlk61588457"><span style="font-size:11.0pt">< 100/µl, (selten < 200/µl)</span></span>
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| | style="width:99.25pt;" width="132" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">häufig multiple Läsionen (Kryptokokkome)</span> </span></span>
| |
| | style="width:3.0cm;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">Basalganglien</span></span></span>
| |
| | style="width:92.15pt;" width="123" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">Leptomeningeales Enhancement, insbesondere bei IRIS</span> </span></span>
| |
| | style="width:150.8pt;" width="201" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">häufig „ punched-out” zystische Läsionen<span style="color: #0060DF"> <span style="mso-spacerun:yes"> </span></span>Zeit von Symptombeginn bis zur klinischen Präsentation: Tage</span></span></span>
| |
| | style="width:177.35pt;" width="236" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">Zellpopulation:</span> <span style="font-size:
| |
| 10.5pt;font-family:"Arial",sans-serif;mso-no-proof:yes">normal bis lymphozytäre Pleozytose <span style="mso-spacerun:yes"> </span> Glucose: normal bis erniedrigt <span style="mso-spacerun:yes"> </span> Protein: normal bis erhöht</span></span></span>
| |
| |- style="height:95.2ptpx;"
| |
| | style="width:84.8pt;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">'''HSV'''</span> </span></span>
| |
| | style="width:85.95pt;" width="115" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">minimal</span> </span></span>
| |
| | style="width:55.8pt;" width="74" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">variabel</span> </span></span>
| |
| | style="width:99.25pt;" width="132" valign="top" |<span style="mso-bookmark:
| |
| _Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:
| |
| "Arial",sans-serif;mso-no-proof:yes">-</span></span></span>
| |
| | style="width:3.0cm;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">Temporallappen</span></span></span>
| |
| | style="width:92.15pt;" width="123" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">häufig Enhancement</span> </span></span>
| |
| | style="width:150.8pt;" width="201" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">Beteiligung des Hirnstamms, Kleinhirn, Diencephalon und der periventrikulären Regionen. <span style="mso-spacerun:yes"> </span>Zeit von Symptombeginn bis zur klinischen Präsentation: Tage</span></span></span>
| |
| | style="width:177.35pt;" width="236" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">Zellpopulation:</span> <span style="font-size:
| |
| 10.5pt;font-family:"Arial",sans-serif;mso-no-proof:yes">in der Regel lymphozytäre Pleozytose <span style="mso-spacerun:yes"> </span> Glucose: normal <span style="mso-spacerun:yes"> </span> Protein: normal bis erhöht</span></span></span>
| |
| |- style="height:99.95ptpx;"
| |
| | style="width:84.8pt;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">'''Tuberkulose'''</span> </span></span>
| |
| | style="width:85.95pt;" width="115" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">Hydrocephalus möglich</span> </span></span>
| |
| | style="width:55.8pt;" width="74" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">variabel</span> </span></span>
| |
| | style="width:99.25pt;" width="132" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">Tuberkulome treten häufig multiple auf</span> </span></span>
| |
| | style="width:3.0cm;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">TB- Meningitis: Infratentoriell mit Basalganglien-/Corticalinfarkten</span></span></span>
| |
| | style="width:92.15pt;" width="123" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">< 50% basales Enhancement</span> </span></span>
| |
| | style="width:150.8pt;" width="201" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">Hämorrhagien, Tuberkulome oder Abszesse möglich <span style="mso-spacerun:yes"> </span> Zeit von Symptombeginn bis zur klinischen Präsentation: Tage bis Wochen</span></span></span>
| |
| <span style="mso-bookmark:_Hlk61588457"></span>
| |
| | style="width:177.35pt;" width="236" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">Zellpopulation:</span> <span style="font-size:
| |
| 10.5pt;font-family:"Arial",sans-serif;mso-no-proof:yes">in der Regel lymphozytäre Pleozytose <span style="mso-spacerun:yes"> </span> Glucose: erniedrigt <span style="mso-spacerun:yes"> </span> Protein: normal bis deutlich erhöht <span style="mso-spacerun:yes"> </span> Sonstiges: Laktat erhöht, schwere Schrankenstörung, IGA-Dominanz(Immunglobulinsynthese), häufig auch pulmonale Beteiligung (CT-Thorax)</span> </span></span>
| |
| |- style="height:67.85ptpx;"
| |
| | style="width:84.8pt;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">'''Hirnabszess'''</span> </span></span>
| |
| | style="width:85.95pt;" width="115" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">möglich</span> </span></span>
| |
| | style="width:55.8pt;" width="74" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">variabel</span></span></span>
| |
| | style="width:99.25pt;" width="132" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">sowohl solitär als auch multiple Läsionen z.B. im Rahmen einer Endokarditis möglich</span></span></span>
| |
| | style="width:3.0cm;" width="113" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="color: black">supratentoriell, insb. im Frontal- und</span> [https://www.amboss.com/de/wissen/Gro%C3%9Fhirn#Zaad99956bd89838c4d6bbb8efd53379b <span style="color: black">Parietallappen</span>]<span style="color: black">, subkortikal</span></span></span>
| |
| | style="width:92.15pt;" width="123" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">T1-Sequenz mit KM: ringförmiges Enhancement</span></span></span>
| |
| <span style="mso-bookmark:_Hlk61588457"></span>
| |
| | style="width:150.8pt;" width="201" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">DWI-Sequenz: Hyperintenses zentrales Areal <span style="mso-spacerun:yes"> </span> Zeit von Symptombeginn bis zur klinischen Präsentation: Tage</span></span></span>
| |
| | style="width:177.35pt;" width="236" valign="top" |<span style="mso-bookmark:_Hlk61588457"><span class="toctext"><span style="font-size:10.5pt;font-family:"Arial",sans-serif;
| |
| mso-no-proof:yes">(bei begleitender Meningitis) Zellpopulation:</span> <span style="font-size:
| |
| 10.5pt;font-family:"Arial",sans-serif;mso-no-proof:yes">in der Regel granulozytäre Pleozytose <span style="mso-spacerun:yes"> </span> Glucose: erniedrigt <span style="mso-spacerun:yes"> </span> Protein: normal bis deutlich erhöht <span style="mso-spacerun:yes"> </span></span> </span></span>
| |
| |}
| |
| <br />
| |
