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Die unerkannte Hirnverletzung im Sport

Das leichte Schädel-Hirn-Trauma und seine Folgen

The undetected brain lesion in sports

Minor traumatic brain injury and its sequelae

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Zusammenfassung

Das leichte Schädel-Hirn-Trauma („minor traumatic brain injury“, mTBI) wird im Sport oft bagatellisiert. Der behandelnde Arzt geht meist davon aus, dass es sich hierbei in den meisten Fällen um eine nicht strukturelle Hirnverletzung handelt, die in jedem Fall eine blande Prognose hat.

Dieser Artikel zeigt, dass es sich auch bei einer mTBI um eine behandlungsbedürftige strukturelle Hirnschädigung mit potentiell lebensbedrohlichen Folgen handeln kann. Die Therapie sollte nach genau festgelegten Richtlinien — wie die der „Concussion in sports“ (CIS-) Gruppe — erfolgen und eine Rückkehr zum Sport sollte erst nach Abklingen jeglicher physischen aber auch kognitiven Symptome erfolgen.

Besonderen Wert ist auf die Erhebung von bereits früher durchgemachten mTBI zu legen, da wiederholte mTBI zu chronisch-degenerativen Schädigungen des Gehirns führen können. Neuropsychologische Tests helfen eine mTBI korrekt zu diagnostizieren und sind wertvolle Parameter in der Verlaufsbeobachtung. Biochemische Marker könnten in Zukunft sowohl zur Diagnosestellung als auch zur Verlaufsprognose eingesetzt werden, ersetzen die Neuroradiologie heute jedoch noch nicht.

Abstract

The minor traumatic brain injury (mTBI) in sports is often looked at as a bagatelle. The treating physician underestimates the severity of the injury suspecting that a mTBI is a nonstructural lesion with an overall excellent prognosis in the majority of the cases.

This paper shows that the minor traumatic brain injury may be a structural brain lesion with potentially life-threatening dangers. The therapy should follow exactly defined guidelines, e.g., stepwise protocol of the Concussion in Sports (CIS-) Group. Return to sports activities should happen only when all physical but also cognitive symptoms have subsided. All mTBIs that have been sustained prior to the actual injury have to be recorded properly because repeated mTBIs may cause chronic degenerative brain damage.

Neuropsychological testing will aid in the correct diagnosis of a mTBI and is a useful parameter in the course of the injury. In the future biochemical markers may serve as indicators of the severity of the brain injury and may also aid in predicting the outcome after TBI. Today biochemical markers do not serve as a substitute for neuroimaging.

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Danksagung

Das Symposium wurde durch folgende Firmen unterstützt: Roche Diagnostik, SUVA, Essex Chemie AG, GlaxoSmithKline AG, IBSA, OPED AG, Pfizer AG, Smith & Nephew AG, Somomedical AG, Stryker Osteonics SA, Tyco Healthcare.

Interessenkonflikt:

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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Authors and Affiliations

  1. Traumatologie, Orthopädie und Sportmedizin, Medical Consultant of the International Ice Hockey Federation IIHF, Spital Oberengadin, Samedan, Schweiz

    N. Biasca

  2. National Hockey League and National Football League Neuropsychology Programs, Sports Concussion Program, University of Pittsburgh, Pittsburgh, USA

    M. R. Lovell

  3. Sports Medicine Concussion Program, University of Pittsburgh Medical Center, Pittsburgh, USA

    M. W. Collins

  4. New York State Athletic Commission, Brain Injury Program, Burke Rehabilitation Hospital, New York, USA

    B. D. Jordan

  5. Neuroscience Centers, Erasmus University of Rotterdam, St. Anna Hospital, Geldrop, Holland

    E. Matser

  6. Department of Neuroscience, Erasmus Medical Center, Rotterdam, Holland

    J. Weber & J. E. Slemmer

  7. IIHF Medical Committee, Member IOC Commission Games Group Sport Medicine Staff, York University, Toronto, Kanada

    P. Piccininni

  8. Anatomy Department of Neuropathology, University of Glasgow and D.Sc. University of Bristol, Glasgow, Großbritannien

    W. Maxwell

  9. FMH Neurologie, Kopfwehzentrum Klinik Hirslanden, Zürich, Schweiz

    R. Agosti

  10. Orthopädie und Sportmedizin, Spital Oberengadin, Samedan, Schweiz

    S. Wirth & T. O. Schneider

  11. Traumatologie, Orthopädie und Sportmedizin, Medical Consultant of the International Ice Hockey Federation IIHF, Spital Oberengadin, CH-7503, Samedan, Schweiz

    N. Biasca

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  1. N. Biasca
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  4. B. D. Jordan
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  5. E. Matser
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  6. J. Weber
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  7. J. E. Slemmer
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  8. P. Piccininni
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  9. W. Maxwell
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  10. R. Agosti
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  11. S. Wirth
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  12. T. O. Schneider
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Additional information

Ein Autor (N.B.) ist „Medical Consultant“ des Internationalen Eishockey Verbandes (IIHF), ein Autor (P. P.) ist Mitglied der medizinischen Kommissionen von IIHF und IOC, ein weiterer Autor (M.R.L.) ist Mitglied der „Concussion in Sports (CIS-) Group“. Der Inhalt dieses Artikels gibt die persönlichen Auffassung der Autoren wieder und spiegelt nicht unbedingt die Ansichten der „Concussion in Sports /CIS-) Group oder der IOC/IIHF/FIFA wieder.

Dieser Artikel basiert auf den Ergebnissen, welche die Concussion in Sports (CIS-) Group in Anschluss an die IOC/IIHF/FIFA International Symposia on Concussion in Sports in Wien (2001) und in Prag (2004) jeweils veröffentlicht hat. Im Literaturverzeichnis sind die jeweiligen Artikel aufgeführt.

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Biasca, N., Lovell, M.R., Collins, M.W. et al. Die unerkannte Hirnverletzung im Sport. Unfallchirurg 109, 101–111 (2006). https://doi.org/10.1007/s00113-005-1046-5

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  • DOI: https://doi.org/10.1007/s00113-005-1046-5

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