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Schädel-Hirn-Trauma

Die Intensivmedizin

Part of the book series: Springer Reference Medizin ((SRM))

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Zusammenfassung

Zentrales Symptom des Schädel-Hirn-Traumas (SHT) ist die Bewusstseinseinschränkung, deren Einteilung sich an der Glasgow Coma Scale orientiert. Dieser Beitrag beschreibt neben Pathophysiologie die Klinik und Diagnostik des SHT. Das therapeutische Vorgehen von der Primärversorgung bis zur intensivmedizinischen Behandlung sind hier dargestellt. Die Therapie bietet konservative und chirurgische Möglichkeiten. Der primäre Hirnschaden wird durch die Schwere des initialen Traumas determiniert. Sämtliche therapeutischen Bemühungen zielen auf die Minimierung eines sekundären Hirnschadens ab, der durch die vom primären Hirnschaden ausgelösten pathophysiologischen Prozesse entsteht. Der Prognose der betroffenen Patienten sowie der aktuellen Forschungslandschaft sind eigene Abschnitte gewidmet.

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Literatur

  • Andriessen TMJC, Horn J, Franschman G et al (2011) Epidemiology, severity classification, and outcome of moderate and severe traumatic brain injury: a prospective multicenter study. J Neurotrauma 28:2019–2031

    Article  PubMed  Google Scholar 

  • Balestreri M, Czosnyka M, Hutchinson P et al (2006) Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury. Neurocrit Care 4:8–13

    Article  PubMed  Google Scholar 

  • Berry C, Ley EJ, Bukur M et al (2012) Redefining hypotension in traumatic brain injury. Injury 43:1833–1837

    Article  PubMed  Google Scholar 

  • Beynon C, Hertle DN, Unterberg AW, Sakowitz OW (2012) Clinical review: traumatic brain injury in patients receiving antiplatelet medication. Crit Care (London, England) 16:228. doi:10.1186/cc11292

    Google Scholar 

  • Bouma GJ, Muizelaar JP (1990) Relationship between cardiac output and cerebral blood flow in patients with intact and with impaired autoregulation. J Neurosurg 73:368–374

    Article  CAS  PubMed  Google Scholar 

  • Bouma GJ, Muizelaar JP, Bandoh K, Marmarou A (1992) Blood pressure and intracranial pressure-volume dynamics in severe head injury: relationship with cerebral blood flow. J Neurosurg 77:15–19

    Article  CAS  PubMed  Google Scholar 

  • Bratton SL, Chestnut RM, Ghajar J et al (2007) Guidelines for the management of severe traumatic brain injury. VIII. Intracranial pressure thresholds. J Neurotrauma 24(Suppl 1):S55–S58

    PubMed  Google Scholar 

  • Bricolo AP, Pasut LM (1984) Extradural hematoma: toward zero mortality. A prospective study. Neurosurgery 14:8–12

    Article  CAS  PubMed  Google Scholar 

  • Bulger EM, May S, Brasel KJ et al (2010) Out-of-hospital hypertonic resuscitation following severe traumatic brain injury: a randomized controlled trial. JAMA 304:1455–1464. doi:10.1001/jama.2010.1405

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Bullock MR, Chesnut R, Ghajar J et al (2006) Surgical management of depressed cranial fractures. Neurosurgery 58:56–60; discussion S i–iv

    Google Scholar 

  • Chang EF, Meeker M, Holland MC (2006) Acute traumatic intraparenchymal hemorrhage: risk factors for progression in the early post-injury period. Neurosurgery 58:647–656; discussion 647–656

    Article  PubMed  Google Scholar 

  • Chesnut RM, Marshall SB, Piek J et al (1993) Early and late systemic hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir Suppl 59:121–125

    CAS  PubMed  Google Scholar 

  • Chesnut RM, Temkin N, Carney N et al (2012) A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 367:2471–2481. doi:10.1056/NEJMoa1207363

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Choong C, Kaye AH (2009) Emil theodor kocher (1841–1917). J Clin Neurosci 16:1552–1554. doi:10.1016/j.jocn.2009.08.002

    Article  PubMed  Google Scholar 

  • Compagnone C, Murray GD, Teasdale GM et al (2007) The management of patients with intradural post-traumatic mass lesions: a multicenter survey of current approaches to surgical management in 729 patients coordinated by the European Brain Injury Consortium. Neurosurgery 61:232–240. doi:10.1227/01.neu.0000279218.53504.fe; discussion 240–241

    Article  PubMed  Google Scholar 

  • Cooper PR, Rovit RL, Ransohoff J (1976) Hemicraniectomy in the treatment of acute subdural hematoma: a re-appraisal. Surg Neurol 5:25–28

    CAS  PubMed  Google Scholar 

  • Cooper DJ, Rosenfeld JV, Murray L et al (2011) Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 364:1493–1502. doi:10.1056/NEJMoa1102077

    Article  CAS  PubMed  Google Scholar 

  • Cucciniello B, Martellotta N, Nigro D, Citro E (1993) Conservative management of extradural haematomas. Acta Neurochir 120:47–52

    Article  CAS  PubMed  Google Scholar 

  • Dagi TF, Meyer FB, Poletti CA (1983) The incidence and prevention of meningitis after basilar skull fracture. Am J Emerg Med 1:295–298

    Article  CAS  PubMed  Google Scholar 

  • Deutsche Gesellschaft für Neurochirurgie (2007) Leitlinien der Deutschen Gesellschaft für Neurochirurgie „Schädel-Hirn-Trauma im Erwachsenenalter.“ AWMF-Leitlinie, Registernummer 008–001 [http://www.awmf.org/leitlinien/detail/ll/008–001.html]

  • Deutsche Gesellschaft für Unfallchirurgie – DGU (2011) S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung. AWMF-Register-Nr. 012/019 [http://www.awmf.org/uploads/tx_szleitlinien/012–019l_S3_Polytrauma_Schwerverletzten-Behandlung_2011–07.pdf]

  • El-Kadi H, Miele VJ, Kaufman HH (2000) Prognosis of chronic subdural hematomas. Neurosurg Clin N Am 11:553–567

    CAS  PubMed  Google Scholar 

  • Farhadi MR, Becker M, Stippich C et al (2009) Transorbital penetrating head injury by a toilet brush handle. Acta Neurochir 151:685–687. doi:10.1007/s00701-009-0221-9

    Article  CAS  PubMed  Google Scholar 

  • Firsching R, Woischneck D, Klein S et al (2001) Classification of severe head injury based on magnetic resonance imaging. Acta Neurochir 143:263–271

    Article  CAS  PubMed  Google Scholar 

  • Frontera JA (2010) Intensive versus conventional insulin therapy in critically ill neurologic patients: still searching for the sweet spot. Neurocrit Care 13:295–298

    Article  PubMed  Google Scholar 

  • Frost EA (1977) Effects of positive end-expiratory pressure on intracranial pressure and compliance in brain-injured patients. J Neurosurg 47:195–200

    Article  CAS  PubMed  Google Scholar 

  • Gaab MR, Rittierodt M, Lorenz M, Heissler HE (1990) Traumatic brain swelling and operative decompression: a prospective investigation. Acta Neurochir Suppl 51:326–328

    CAS  PubMed  Google Scholar 

  • Gennareli D, Grahahm T (2000) Pathology of brain damage after head injury. In: Cooper P, Golfinos G (Hrsg) Head injury. 4. Aufl. Morgan Hill, New York

    Google Scholar 

  • Gobiet W, Grote W, Bock WJ (1975) The relation between intracrainal pressure, mean arterial pressure and cerebral blood flow in patients with severe head injury. Acta Neurochir 32:13–24

    Article  CAS  PubMed  Google Scholar 

  • Gudeman SK, Kishore PR, Miller JD et al (1979) The genesis and significance of delayed traumatic intracerebral hematoma. Neurosurgery 5:309–313

    Article  CAS  PubMed  Google Scholar 

  • Guerra WK, Gaab MR, Dietz H et al (1999a) Surgical decompression for traumatic brain swelling: indications and results. J Neurosurg 90:187–196. doi:10.3171/jns.1999.90.2.0187

    Article  CAS  PubMed  Google Scholar 

  • Guerra WK, Piek J, Gaab MR (1999b) Decompressive craniectomy to treat intracranial hypertension in head injury patients. Intensive Care Med 25:1327–1329

    Article  CAS  PubMed  Google Scholar 

  • Hamilton M, Wallace C (1992) Nonoperative management of acute epidural hematoma diagnosed by CT: the neuroradiologist’s role. AJNR Am J Neuroradiol 13:853–859; discussion 860–862

    CAS  PubMed  Google Scholar 

  • Heary RF, Hunt CD, Krieger AJ et al (1993) Nonsurgical treatment of compound depressed skull fractures. J Trauma 35:441–447

    Article  CAS  PubMed  Google Scholar 

  • Hiler M, Czosnyka M, Hutchinson P et al (2006) Predictive value of initial computerized tomography scan, intracranial pressure, and state of autoregulation in patients with traumatic brain injury. J Neurosurg 104:731–737

    Article  PubMed  Google Scholar 

  • Hutchinson PJ, Menon DK, Kirkpatrick PJ (2005) Decompressive craniectomy in traumatic brain injury – time for randomised trials? Acta Neurochir 147:1–3. doi:10.1007/s00701-004-0400-7

    Article  CAS  PubMed  Google Scholar 

  • Hutchinson PJ, Corteen E, Czosnyka M et al (2006) Decompressive craniectomy in traumatic brain injury: the randomized multicenter RESCUEicp study (www.RESCUEicp.com). Acta Neurochir Suppl 96:17–20

    Article  CAS  PubMed  Google Scholar 

  • Jennett B (1996) Epidemiology of head injury. J Neurol Neurosurg Psychiatry 60:362–369

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1:480–484

    Article  CAS  PubMed  Google Scholar 

  • Kaufman HH, Moake JL, Olson JD et al (1980) Delayed and recurrent intracranial hematomas related to disseminated intravascular clotting and fibrinolysis in head injury. Neurosurgery 7:445–449

    Article  CAS  PubMed  Google Scholar 

  • Khaled CN, Raihan MZ, Chowdhury FH, Ashadullah ATM, Sarkar MH, Hossain SS (2008) Surgical management of traumatic extradural haematoma: experiences with 610 patients and prospective analysis. Indian J Neurotrauma 5:75–79

    Article  Google Scholar 

  • Lane PL, Skoretz TG, Doig G, Girotti MJ (2000) Intracranial pressure monitoring and outcomes after traumatic brain injury. Can J Surg J Can Chir 43:442–448

    CAS  Google Scholar 

  • Maas AIR (2002) Guidelines for head injury: their use and limitations. Neurol Res 24:19–23

    Article  PubMed  Google Scholar 

  • Maas AI, Dearden M, Teasdale GM et al (1997) EBIC-guidelines for management of severe head injury in adults. European Brain Injury Consortium. Acta Neurochir 139:286–294

    Article  CAS  PubMed  Google Scholar 

  • Machulda MM, Haut MW (2000) Clinical features of chronic subdural hematoma: neuropsychiatric and neuropsychologic changes in patients with chronic subdural hematoma. Neurosurg Clin N Am 11:473–477

    CAS  PubMed  Google Scholar 

  • Manolakaki D, Velmahos GC, Spaniolas K et al (2009) Early magnetic resonance imaging is unnecessary in patients with traumatic brain injury. J Trauma 66:1008–1012; discussion 1012–1014

    Article  PubMed  Google Scholar 

  • Martin NA, Patwardhan RV, Alexander MJ et al (1997) Characterization of cerebral hemodynamic phases following severe head trauma: hypoperfusion, hyperemia, and vasospasm. J Neurosurg 87:9–19

    Article  CAS  PubMed  Google Scholar 

  • Mauritz W, Janciak I, Wilbacher I, Rusnak M (2007) Severe traumatic brain injury in Austria IV: intensive care management. Wien Klin Wochenschr 119:46–55

    Article  PubMed  Google Scholar 

  • Mayer AR, Ling J, Mannell MV et al (2010) A prospective diffusion tensor imaging study in mild traumatic brain injury. Neurology 74:643–650

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Perel P, Arango M, Clayton T et al (2008) Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ (Clin Res edn) 336:425–429

    Article  Google Scholar 

  • Piek J (2002) Decompressive surgery in the treatment of traumatic brain injury. Curr Opin Crit Care 8:134–138

    Article  PubMed  Google Scholar 

  • Ratilal BO, Costa J, Sampaio C, Pappamikail L (2011) Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev CD004884. doi:10.1002/14651858.CD004884.pub3

    Google Scholar 

  • Rehman L, Ghani E, Hussain A (2007) Infection in compound depressed fracture of the skull. J Coll Physicians Surg Pak 17:140–143. doi:03.2007/JCPSP.140143

    PubMed  Google Scholar 

  • Resnick DK, Subach BR, Marion DW (1997) The significance of carotid canal involvement in basilar cranial fracture. Neurosurgery 40:1177–1181

    Article  CAS  PubMed  Google Scholar 

  • Rickels E, von Wild K, Wenzlaff PBW (2006) Schädel-Hirn-Verletzung, Epidemiologie und Versorgung, Ergebnisse einer prospektiven Studie. Zuckerschwerdt, München

    Google Scholar 

  • Rickels E, von Wild K, Wenzlaff P (2010) Head injury in Germany: a population-based prospective study on epidemiology, causes, treatment and outcome of all degrees of head-injury severity in two distinct areas. Brain Inj : [BI] 24:1491–1504

    Article  Google Scholar 

  • Rickels E, von Wild K, Wenzlaff P (2011) Treatment of traumatic brain injury in Germany. Unfallchirurg 114:417–423

    Article  CAS  PubMed  Google Scholar 

  • Roberts I, Yates D, Sandercock P et al (2004) Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial. Lancet 364:1321–1328

    Article  PubMed  Google Scholar 

  • Roberts DJ, Chaubey VP, Zygun DA et al (2013) Diagnostic accuracy of computed tomographic angiography for blunt cerebrovascular injury detection in trauma patients: a systematic review and meta-analysis. Ann Surg 257:621–632

    Article  PubMed  Google Scholar 

  • Roozenbeek B, Maas AIR, Menon DK (2013) Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol 9:231–236

    Article  PubMed  Google Scholar 

  • Rosner MJ, Rosner SD, Johnson AH (1995) Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 83:949–962

    Article  CAS  PubMed  Google Scholar 

  • Sahuquillo J, Arikan F (2006) Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database Syst Rev CD003983. doi:10.1002/14651858.CD003983.pub2

    Google Scholar 

  • Sarrafzadeh AS, Sakowitz OW, Callsen TA et al (2002) Detection of secondary insults by brain tissue pO2 and bedside microdialysis in severe head injury. Acta Neurochir Suppl 81:319–321

    CAS  PubMed  Google Scholar 

  • Scholsem M, Scholtes F, Collignon F et al (2008) Surgical management of anterior cranial base fractures with cerebrospinal fluid fistulae: a single-institution experience. Neurosurgery 62:463–469. doi:10.1227/01.neu.0000316014.97926.82; discussion 469–471

    Article  PubMed  Google Scholar 

  • Seelig JM, Becker DP, Miller JD et al (1981) Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. N Engl J Med 304:1511–1518. doi:10.1056/NEJM198106183042503

    Article  CAS  PubMed  Google Scholar 

  • Smits M, Dippel DWJ, de Haan GG et al (2005) External validation of the Canadian CT Head Rule and the New Orleans Criteria for CT scanning in patients with minor head injury. JAMA 294:1519–1525. doi:10.1001/jama.294.12.1519

    Article  CAS  PubMed  Google Scholar 

  • Stiell IG, Clement CM, Rowe BH et al (2005) Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury. JAMA 294:1511–1518. doi:10.1001/jama.294.12.1511

    Article  CAS  PubMed  Google Scholar 

  • Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84

    Article  CAS  PubMed  Google Scholar 

  • The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons. The joint section on neurotrauma and critical care. Critical pathway for the treatment of established intracranial hypertension. J Neurotrauma 17:537–538

    Article  Google Scholar 

  • Thomas BW, Mejia VA, Maxwell RA et al (2010) Scheduled repeat CT scanning for traumatic brain injury remains important in assessing head injury progression. J Am Coll Surg 210(824–30):831–832

    Google Scholar 

  • Timmons SD, Ullman JS, Eisenberg HM (2011) Craniectomy in diffuse traumatic brain injury. N Engl J Med 365:373; author reply 376

    Article  CAS  PubMed  Google Scholar 

  • Tseng W-C, Shih H-M, Su Y-C et al (2011) The association between skull bone fractures and outcomes in patients with severe traumatic brain injury. J Trauma 71:1611–1614; discussion 1614

    Article  PubMed  Google Scholar 

  • Tsutsumi K, Maeda K, Iijima A et al (1997) The relationship of preoperative magnetic resonance imaging findings and closed system drainage in the recurrence of chronic subdural hematoma. J Neurosurg 87:870–875

    Article  CAS  PubMed  Google Scholar 

  • Urbano LA, Oddo M (2012) Therapeutic hypothermia for traumatic brain injury. Curr Neurol Neurosci Rep 12:580–591

    Article  CAS  PubMed  Google Scholar 

  • Wan Y, Li X, Qian C et al (2013) The comparison between dissociate bone flap cranioplasty and traditional cranioplasty in the treatment of depressed skull fractures. J Craniofac Surg 24:589–591

    Article  PubMed  Google Scholar 

  • Young HA, Gleave JR, Schmidek HH, Gregory S (1984) Delayed traumatic intracerebral hematoma: report of 15 cases operatively treated. Neurosurgery 14:22–25

    Article  CAS  PubMed  Google Scholar 

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Scherer, M., Younsi, A., Unterberg, A.W. (2015). Schädel-Hirn-Trauma. In: Marx, G., Muhl, E., Zacharowski, K. (eds) Die Intensivmedizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54675-4_89-1

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  1. Latest

    Schädel-Hirn-Trauma
    Published:
    10 December 2022

    DOI: https://doi.org/10.1007/978-3-642-54675-4_89-2

  2. Original

    Schädel-Hirn-Trauma
    Published:
    22 June 2015

    DOI: https://doi.org/10.1007/978-3-642-54675-4_89-1