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Das einfache Schädel-Hirn-Trauma

Diagnostische Fallen und Komplikationen

Mild head injury

Diagnostic pitfalls and complications

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Zusammenfassung

Zum Management des einfachen Schädel-Hirn-Trauma (SHT) gibt es keinen allgemeinen Konsens im Hinblick auf das diagnostische und therapeutische Vorgehen. Die Bewertung klinischer Befunde und die Indikation von Röntgenuntersuchungen werden kontrovers diskutiert, vor allem auch unter dem Aspekt der Strahlenbelastung und ihrer Risiken. Wichtige Kriterien in der Beurteilung des SHT sind die Kenntnis seiner möglichen Zeitphasen mit primärer und sekundärer Bewusstlosigkeit und freiem Intervall, die Art und Entwicklungsdynamik der sekundären intrakraniellen Verletzungsfolgen (epi- oder subdurales Hämatom, Hirnkontusion, Hirnschwellung und Hirnödem) sowie die Wertigkeit von neurologischen Befunden, vegetativen Begleiterscheinungen und Befunden der Computertomographie und Röntgen-Schädel-Diagnostik. Anhand dieser Parameter wird ein Algorithmus für ein adäquates Management der Diagnostik und der Behandlung von Patienten mit leichtem SHT aufgestellt.

Abstract

With regard to diagnosis and treatment, there is no general agreement about the management of mild head injury. The value of clinical discoveries and the indications for x-ray investigations are controversially discussed, as well as the risks of radiation exposure. Important criteria in the judgment of mild head injury are knowledge of its possible stages over time (primary and secondary unconsciousness and symptom free interval), the dynamics of secondary intracranial injury development (epidural or subdural hematoma, brain contusion, brain swelling, brain edema), and the priority given to neurologic findings, accompanying vegetative symptoms and computerized tomography and x-ray results. By means of these parameters, an algorithm for appropriately managing the diagnostics and processing of patients with mild head injury has been created.

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Literatur

  1. Cassidy J, Carroll L, Peloso P et al. (2004) Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med (Suppl) 43: 28–60

    Article  Google Scholar 

  2. Dacey RG Jr, Alves WM, Rimel RW et al. (1986) Neurosurgical complications after apparently minor head injury. Assessment of risk in a series of 610 patients. J Neurosurg 65: 203–210

    PubMed  Google Scholar 

  3. Davis RL, Mullen N, Makela M et al. (1994) Cranial computed tomography scans in children after minimal head injury with loss of consciousness. Ann Emerg Med 24: 713–714

    Article  Google Scholar 

  4. Fabbri A, Servadei F, Marchesini G et al. (2004) Prospective validation of a proposal for diagnosis and management of patients attending the emergency department for mild head injury. J Neurol Neurosurg Psychiatry 75: 410–416

    Article  PubMed  CAS  Google Scholar 

  5. Fabbri A, Servadei F, Marchesini G et al. (2008) Early predictors of unfavourable outcome in subjects with moderate head injury in the emergency department. J Neurol Neurosurg Psychiatry 79: 567–573

    Article  PubMed  CAS  Google Scholar 

  6. Halley MK, Silva PD, Foley J, Rodarte (2005) Loss of consciousness: when to perform computed tomography? Pediatr Crit Care Med 6: 93–94

    Google Scholar 

  7. Haydel MJ, Shembekar AD (2003) Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to nontrivial mechanisms. Ann Emerg Med 42: 515–518

    Article  Google Scholar 

  8. Holmes JF, Palchak MJ, MacFarlane T, Kuppermann N (2005) Performance of the pediatric glasgow coma scale in children with blunt head trauma. Pediatr Rehabil 8: 92–103

    Google Scholar 

  9. Ibañez J, Arikan F, Pedraza S et al. (2004) Reliability of clinical guidelines in the detection of patients at risk following mild head injury: results of a prospective study. J Neurosurg 100: 825–834

    PubMed  Google Scholar 

  10. Jennett B, Teasdale G, Galbraith S et al. (1977) Severe head injury in three countries. J Neurol Neurosurg Psychiatry 40: 291–298

    PubMed  CAS  Google Scholar 

  11. Kobrine AJ, Timmons E, Rajjoub JK (1977) Demonstration of massive traumatic brain swelling within 20 minutes after injury. J Neurosurg 46: 256–258

    PubMed  CAS  Google Scholar 

  12. Kolodziejczyk D, Grumme T (1988) Komplikationen bei chronisch subduralen Hämatomen. In: Bock WJ, Schirmer M (Hrsg) Komplikationen bei neurochirurgischen Eingriffen. Zuckschwerdt, München Bern Wien San Franzisko, S 82–86

  13. Livingston DH, Lavery RF, Passannante MR et al. (2000) Emergency department discharge of patients with a negative cranial computed tomography scan after minimal head injury. Ann Surg 232: 126–132

    Article  PubMed  CAS  Google Scholar 

  14. Lobato RD, Rivas JJ, Gomez PA et al. (1991) Head-injured patients who talk and deteriorate into coma. Analysis of 211 cases studied with computerized tomography. J Neurosurg 75: 256–261

    PubMed  CAS  Google Scholar 

  15. Marshall LF, Gautille T, Klauber MR et al. (1991) The outcome of severe closed head injury. J Neurosurg 75 (Suppl): S28–S36

    Google Scholar 

  16. Meares S, Shores EA, Taylor AJ et al. (2008) Mild traumatic brain injury does not predict acute postconcussion syndrome. J Neurol Neurosurg Psychiatry 79: 237

    Article  Google Scholar 

  17. Murshid WR (1998) Management of minor head injuries: admission criteria, radiological evaluation and treatment of complications. Acta Neurochir (Wien) 140: 56–64

    Google Scholar 

  18. Quayle KS, Jaffe DM, Kuppermann N et al. (1997) Diagnostic testing for acute head injury in children: When are head computed tomography and skull radiographs indicated? Pediatrics 99: e11

    Article  PubMed  CAS  Google Scholar 

  19. Richard KE, Karimi A (1986) Treatment of intracranial hypertension without barbiturates. Adv Neurosurg 14: 317–323

    Google Scholar 

  20. Saboori M, Ahmadi J, Farajzadegan Z (2007) Indications for brain CT scan in patients with minor head injury. Clin Neurol Neurosurg 109: 399–405

    Article  PubMed  Google Scholar 

  21. Simon B, Letourneau P, Vitorino E, McCall J (2001) Pediatric minor head trauma: indications for computed tomographic scanning revisited. J Trauma 51: 231–237; discussion 237–238

    PubMed  CAS  Google Scholar 

  22. Smits M, Dippel DW, Steyerberg EW et al. (2007) Predicting intracranial traumatic findings on computed tomography in patients with minor head injury: the CHIP prediction rule. Ann Intern Med 146: 397–405

    PubMed  Google Scholar 

  23. Statistisches Bundesamt Deutschland (1999) Statistisches Jahrbuch 1999, Wiesbaden

  24. Stein SC, Ross SE (1993) Mild head injury: a plea for routine early CT scanning. J Trauma 3: 491

    Article  Google Scholar 

  25. Thiruppathy SP, Muthukumar N (2004) Mild head injury: revisited. Acta Neurochir (Wien) 146: 1075–1082; discussion 1082–1083

    Google Scholar 

  26. Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 13: 81–84

    Article  Google Scholar 

  27. Wang MY, Griffith P, Sterling J et al. (2000) A prospective population-based study of pediatric trauma patients with mild alterations in consciousness (Glasgow Coma Scale score of 13–14). Neurosurgery 46: 1093–1099

    Article  PubMed  CAS  Google Scholar 

  28. Waga S, Tochio H, Sakakura M (1979) Traumatic cerebral swelling developing within 30 minutes after injury. Surg Neurol 11: 191–193

    PubMed  CAS  Google Scholar 

  29. Weber J, Spring A (2001) Management eines leichten Schädel-Hirn-Traumas im Sport. Dtsch Z Sportmed 52: 297–298

    Google Scholar 

  30. Yanar H, Demetriades D, Hadjizacharia P et al. (2007) Pedestrians injured by automobiles: risk factors for cervical spine injuries. J Am Coll Surg 205: 794–799. Epub 2007 Sep 17

    Article  PubMed  Google Scholar 

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  1. Klinik für Neurochirurgie und Neuroradiologie, Epilepsiechirurgie, Behandlungszentrum Vogtareuth, Krankenhausstraße 20, 83569, Vogtareuth, Deutschland

    D. Kolodziejczyk

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Kolodziejczyk, D. Das einfache Schädel-Hirn-Trauma. Unfallchirurg 111, 486–492 (2008). https://doi.org/10.1007/s00113-008-1452-6

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