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Traumatische Hirnstammläsionen im Kindesalter

Traumatic brain stem lesions in children

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Zusammenfassung

Grundlagen: Zahlreiche Studien unterstreichen die Aussagekraft der initialen Glasgow Coma Scale (GCS) nach einem Schädel-Hirntrauma für den weiteren klinischen Verlauf. Ziel dieser retrospektiven Studie war es, prognostische Faktoren für den klinischen Ausgang von Kindern mit traumatischen Hirnstammläsionen zu ermitteln.

Methodik: Insgesamt wurden in den letzten 16 Jahren 1108 Kinder mit einem Schädel-Hirntrauma untersucht, wovon 23 Patienten klinische und/oder radiologische Zeichen einer Hirnstammläsion aufwiesen. Die initiale neurologische Beurteilung erfolgte durch Bewertung mit dem GCS. Unsere Studie verglich den initialen GCS mit dem klinischen Verlauf unter Zuhilfenahme der Glasgow Outcome Scale (GOS).

Ergebnisse: Bei 13 Patienten (57%) waren neben der Hirnstammsymptomatik entsprechende morphologische Läsionen in der CT bzw. MRI erkennbar. 7 Patienten (30%) wiesen nur klinische Zeichen einer Hirnstammaffektion auf, während 3 Patienten (13%) eindeutig morphologische Läsionen ohne entsprechendes klinisches Korrelat zeigten. Patienten mit einem GCS von 3 bis 4 Punkten (n = 15) zeigten einen signifikanten Unterschied (p < 0,001) im Langzeitverlauf (GOS) gegenüber jenen Patienten (n = 8) mit einem initialen GCS von 5 bis 7 Punkten.

Schlußfolgerungen: Die Ergebnisse lassen einen direkten Zusammenhang zwischen Ausgang und initialem klinischem Befund erkennen, jedoch keinen mit dem im CT verifizierten Befund. Hinsichtlich der Hirnstammläsionen erwies sich das MRI als die sensitivere Methode.

Summary

Background: A great number of studies have indicated that Glasgow Come Scale (GCS) is a prognostic factor for the outcome of patients with brain injuries. The goal of this study was to investigate the outcome in children with traumatic brain stem lesions with regard to initial GCS and morphological patterns.

Methods: We investigated a total of 1108 children with brain injuries during the last 16 years. From the entire series only 23 presented clinical signs of brain stem lesions and/or morphological correlates. Clinical findings were assessed according to the GCS and compared with the Glasgow Outcome Scale (GOS).

Results: 13 (57%) out of these 23 children showed morphological lesions on CT scans combined with clinical signs, 7 children (13%) had obvious clinical symptoms but no morphologically justified lesion. 3 patients (13%) revealed morphological lesions on CT scans without typical clinical signs. There is a significance in outcome (GOS) between patients with initial GCS 3 to 4 and GCS 5 to 7 (p < 0.001).

Conclusions: Results indicate a correlation of outcome with initial clinical findings (GCS) but not necessarily with morphological patterns. CT scand are less sensitive than MRI for such located lesions.

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Authors and Affiliations

  1. Universitätsklinik für Neurochirurgie, Auenbruggerplatz 29, A-8036, Graz, Austria

    J. A. Legat, H. G. Eder, M. Trummer & R. W. Oberbauer

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  1. J. A. Legat
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  2. H. G. Eder
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  3. M. Trummer
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  4. R. W. Oberbauer
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Legat, J.A., Eder, H.G., Trummer, M. et al. Traumatische Hirnstammläsionen im Kindesalter. Acta Chir Austriaca 29, 344–346 (1997). https://doi.org/10.1007/BF02619905

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  • DOI: https://doi.org/10.1007/BF02619905

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