Skip to main content
SpringerLink
Log in

Irreführende Anisokorie bei komatöser 15-Jähriger mit Kopfverletzung

Misleading anisocoria in a comatose 15-year-old with head injury

  • Kasuistiken
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Anisokorie mit Vigilanzverschlechterung nach stumpfem Schädel-Hirn-Trauma wird oft mit raumfordernden intrakraniellen Prozessen in Verbindung gebracht. Zeichen offensichtlicher Gewalteinwirkung auf den Schädel und Übelkeit bzw. Erbrechen erhärten eine diesbezügliche Verdachtsdiagnose. Wir berichten über eine komatöse 15-jährige Schülerin (Glasgow-Coma-Scale = 3 Punkte), die diese genannten Symptome nach einem Sturz unter Alkoholeinwirkung zeigte. Nach prähospitaler Sicherung der Vitalfunktionen und Transport in ein Traumazentrum wurde ein Computertomogramm (CT) angefertigt, das den unerwarteten Befund einer Augenprothese zeigte. Augenprothesen, die nach Enukleationstherapie bei Retinoblastomen oder irreparablen traumatischen Augenläsionen implementiert werden, können täuschend echt wirken. Eine ausführliche neurologische Untersuchung ist bei Notfallpatienten unter Zeitdruck oft schwierig, sollte aber die Überprüfung des Kornealreflexes und die Palpation des Bulbus beinhalten. Unabhängig vom Pupillenstatus ist der schnelle Transport in eine Klinik mit CT und neurochirurgischer Bereitschaft schon alleine wegen der Bewusstlosigkeit und der Traumaanamnese indiziert.

Abstract

Anisocoria after blunt head trauma, associated with altered vigilance, is not unusually assumed to expanding intracranial mass lesion. Obvious signs of head-trauma and vomiting might strengthen this diagnosis. We report from an unconscious 15-year-old girl (Glasgow-Coma-Scale score 3) that showed these symptoms secondary after head-trauma due to alcohol intoxication but turned out to be misleading after cranial computed tomography (CT). Surprisingly, an artificial eye was found that previously remained undetected in clinical examination. Artificial eyes implemented after enucleation therapy in retinoblastoma or eye-trauma are nowadays perfectly fitting. Prehospital discrimination of artificial eyes and natural eyes might be difficult in comatose emergency patients. Neurological examination should check corneal reflex and manual palpation of the bulbus. Independent from anisocoria, patients presenting GCS 3 and head injury need rapid admission to CT-diagnostic, neurosurgical treatment respectively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Adelson PD, Bratton SL, Carney NA et al. (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents. Pediatr Crit Care Med 4(Suppl 3): 1–75

    Article  Google Scholar 

  2. Ando S, Otani M, Moritake K (1992) Clinical analysis of post-traumatic vomiting. Acta Neurochir (Wien) 119: 97–100

    Google Scholar 

  3. Byrnes DP (1979) Head injury and the dilated pupill. Am Surg 45: 139–143

    PubMed  CAS  Google Scholar 

  4. Chesnut RM, Gautille T, Blunt BA et al. (1994) The localizing value of asymmetry in pupillary size in severe head injury: relation to lesion type and localisation. Neurosurgery 34: 840–846

    Article  PubMed  CAS  Google Scholar 

  5. Cohen JE, Montero A, Israel ZH (1996) Prognosis and clinical relevance of anisocoria-craniotomy latency for epidural hematoma in comatose patients. J Trauma 41: 120–122

    Article  PubMed  CAS  Google Scholar 

  6. Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (1997) Leitlinie zur Primärversorgung von Patienten mit Schädel-Hirn-Trauma. Anaesth Intensivmed 38: 89–93

    Google Scholar 

  7. Dias MS, Lillis KA, Calvo C et al. (2004) Management of accidental minor head injuries in children: a prospective outcomes study. J Neurosurg 101(Suppl 1): 38–43

    PubMed  Google Scholar 

  8. Doz F (2006) Retinoblastoma: a review. Arch Pediatr 13: 1329–1337

    Article  PubMed  CAS  Google Scholar 

  9. Dunning J, Batchelor J, Stratford-Smith P et al. (2004) A meta-analysis of variables that predict significant intracranial injury in minor head trauma. Arch Dis Child 89: 653–659

    Article  PubMed  CAS  Google Scholar 

  10. Fischer B, Witt J (2007) Das Schädel-Hirn-Trauma des Kindes in der Notfallambulanz. Unfallchirurg 110: 226–232

    Article  PubMed  CAS  Google Scholar 

  11. Odell MS (1998) Drug-induced anisocoria in two detainees. J Clin Forensic Med 5: 10–12

    Article  PubMed  CAS  Google Scholar 

  12. Gutmann MB, Moulton RJ, Sullivan I et al. (1992) Risc factors predicting operable intracranial hematomas in head injury. J Neurosurg 77: 9–14

    Google Scholar 

  13. Moppett IK (2007) Traumatic brain injury: assessment, resuscitation and early management. Br J Anaesth 99: 18–31

    Article  PubMed  CAS  Google Scholar 

  14. National Institute for Clinical Excellence (2003) Head Injury triage, assessment, investigation and early management of head injury in infants, children and adults. Clinical guideline 4 June 2003, National Institute for Clinical Excellence, London, http://www.nice.org/

  15. Salluzo RF, Freed HA, Watts C et al. (1992) Looking at your options: how to manage the head-injured patient. Emerg Med 13: 53–64

    Google Scholar 

  16. SperryJL, Gentilello LM, Minei JP et al. (2006) Waiting for the patient to „sober up“: Effect of alcohol intoxication on glasgow coma scale score of brain injured patients. J Trauma 61: 1305–1311

    Google Scholar 

  17. Stuke L, Diaz-Arrastia R, Getilello LM, Shafi S (2007) Effect of alcohol on Glasgow Coma Scale in head-injured patients. Ann Surg 245: 651–655

    Article  PubMed  Google Scholar 

  18. The Brain Trauma Foundation (2007) Guidelines for the management of severe traumatic brain injury. J Neurotrauma (Suppl 1) 24: S7–S13

  19. Thomson S, Pilley SF (1976) Unequal pupills. A flowchart for sorting out the anisocorias. Surv Ophthalmol 21: 45–48

    Article  Google Scholar 

  20. Valovich McLeod TC (2005) The Prediction of intracranial injury after minor head trauma in the pediatric population. J Athl Train 40: 123–125

    Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Operative Intensivstation, Klinik für Anaesthesiologie, Intensiv- und Notfallmedizin, BG-Kliniken Bergmannstrost, Merseburger Straße 165, 06112, Halle, Deutschland

    M.F. Struck,  R. Stuttmann & P. Hilbert

  2. Klinik für Bildgebende Diagnostik und Interventionsradiologie, BG-Kliniken Bergmannstrost, Halle, Deutschland

    H. Bergert & I. Kaden

  3. Klinik für Neurochirurgie, BG-Kliniken Bergmannstrost, Halle, Deutschland

    C. Hohaus

Authors
  1. M.F. Struck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Bergert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Hohaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I. Kaden
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Stuttmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Hilbert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M.F. Struck.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Struck, M., Bergert, H., Hohaus, C. et al. Irreführende Anisokorie bei komatöser 15-Jähriger mit Kopfverletzung. Unfallchirurg 111, 940–943 (2008). https://doi.org/10.1007/s00113-008-1413-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-008-1413-0

Schlüsselwörter

Keywords

Search

Navigation