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Zerebrale Funktionen bei hirngeschädigten Patienten

Was bedeuten Koma, „vegetative state“, „minimally conscious state“, Locked-in-Syndrom“ und Hirntod?

Cerebral functions in brain-damaged patients

What is meant by coma, vegetative state, minimally conscious state, locked-in syndrome and brain death?

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Zusammenfassung

Komatöse, „Vegatative-state-“ (VS-), „Minimally-conscious-state-“ (MCS-) oder Locked-in-Patienten stellen ein Problem für die Diagnose, Prognose, Behandlung und tägliche Betreuung auf der Intensivstation dar. Am Patientenbett ist die Evaluation möglicher kognitiver Funktionen schwierig, weil willentliche Bewegungen möglicherweise sehr gering, unregelmäßig oder für die Patienten schnell erschöpfend sind. Funktionelle neurologische Bildgebungsverfahren können die klinische Einschätzung von Patienten mit veränderten Bewusstseinszuständen nicht ersetzen. Dennoch kann objektiv beschrieben werden, wie stark die zerebrale Aktivität und ihre regionale Verteilung in Ruhe und unter Stimulation vom Normalzustand abweichen. Durch Quantifizierung der Gehirnaktivität können Patienten differenziert werden, die sich manchmal nur durch ein kurzes und unvollständiges Blinzeln voneinander unterscheiden. Nach unserer Meinung werden Positronenemissionstomographie (PET) und die künftige Nutzung von „functional magnetic resonance imaging“ (fMRI) unser Verständnis schwer hirngeschädigter Patienten substanziell erweitern.

Abstract

Comatose, vegetative, minimally conscious or locked-in patients represent a problem in terms of diagnosis, prognosis, treatment and everyday management at the intensive care unit. The evaluation of possible cognitive functions in these patients is difficult because voluntary movements may be very small, inconsistent and easily exhausted. Functional neuroimaging cannot replace the clinical assessment of patients with altered states of consciousness. Nevertheless, it can describe objectively how deviant from normal the cerebral activity is and its regional distribution at rest and under various conditions of stimulation. The quantification of brain activity differentiates patients who sometimes only differ by a brief and incomplete blink of an eye. In the present paper, we will first try to define consciousness as it can be assessed at the patient’s bedside. We then review the major clinical entities of altered states of consciousness encountered in the intensive care unit. Finally, we discuss the functional neuroanatomy of these conditions as assessed by positron emission tomography (PET) scanning.

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Danksagung

Diese Arbeit wurde unterstützt durch Fördermittel des Fonds National de la Recherche Scientifique de Belgique (FNRS), des Special Funds for Scientific Research of the University of Liège, the CHU Sart Tilman Hospital, the Mind Science Foundation Texas, und durch die Belgian Queen Elisabeth Medical Foundation. SL ist Research Associate beim FNRS. Wir danken Gerhard Scharbert für seine Übersetzungsarbeit.

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Authors and Affiliations

  1. Cyclotron Research Center, CHU Sart Tilman, University of Liège, Belgium

    A. Luxen, P. Maquet & S. Laureys MD PhD

  2. Department of Neurology, CHU Sart Tilman, University of Liège, Belgium

    B. Sadzot, G. Franck, G. Moonen, P. Maquet & S. Laureys MD PhD

  3. Department of Anesthesiology and Intensive Care Medicine, CHU Sart Tilman, University of Liège, Belgium

    M.-E. Faymonville, P. Damas & M. Lamy

  4. Department of Internal Medicine, CHU Sart Tilman, University of Liège, Belgium

    B. Lambermont

  5. PET/Biomedical Cyclotron Unit, ULB Erasme, Brussels, Belgium

    X. de Tiège, P. van Bogaert, S. Goldman & S. Laureys MD PhD

  6. Department of Intensive Care, ULB Erasme, Brussels, Belgium

    J. Berré & M. Ferring

  7. Department of Neurology, ULB Erasme, Brussels, Belgium

    N. Mavroudakis

  8. LIS e.V., Berlin, Germany

    K.-H. Pantke

  9. University, CRC Sart Tilman B30, 4000 , Liège, Belgium

    S. Laureys MD PhD

Authors
  1. M.-E. Faymonville
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  2. K.-H. Pantke
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  3. J. Berré
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  4. B. Sadzot
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  5. M. Ferring
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  6. X. de Tiège
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  7. N. Mavroudakis
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  8. P. van Bogaert
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  9. B. Lambermont
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  10. P. Damas
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  11. G. Franck
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  12. M. Lamy
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  13. A. Luxen
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  14. G. Moonen
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  15. S. Goldman
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  16. P. Maquet
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  17. S. Laureys MD PhD
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Correspondence to S. Laureys MD PhD.

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Faymonville, ME., Pantke, KH., Berré, J. et al. Zerebrale Funktionen bei hirngeschädigten Patienten. Anaesthesist 53, 1195–1202 (2004). https://doi.org/10.1007/s00101-004-0747-4

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