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Nichtakzidentelle Kopfverletzungen und Schütteltrauma

Klinische und pathophysiologische Aspekte

Non-accidental head injury and shaking baby syndrome

Clinical and pathophysiological aspects

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Zusammenfassung

Verletzungen des Zentralnervensystems, insbesondere das Schütteltrauma, führen bei über zwei Drittel der Überlebenden zu oft ausgeprägten neurologischen Folgeschäden; die Letalität beträgt 12–27%. Typisch ist die Konstellation subduraler Hämatome und meist ausgeprägter retinaler Blutungen mit schweren diffusen Hirnschäden, in der Regel ohne äußerlich sichtbare Verletzungen. Ein Schütteltrauma mit signifikanten Folgeschäden erfordert massives, heftiges, gewaltsames Schütteln eines Kindes, das zu unkontrolliertem Umherrotieren des Kopfes führt. Dadurch kommt es zu subduralen und retinalen Blutungen, die für die Prognose jedoch nicht entscheidend sind. Pathogenetisch wird die Kombination diffuser axonaler Traumatisierung mit einer traumatischen Apnoe mit konsekutiver Hypoxie und Ischämie für die ausgeprägten Gehirnschäden bis hin zu einem diffusen Hirnödem angeschuldigt. Klinische Hinweise sind Irritabilität, Trinkschwierigkeiten, Somnolenz, Apathie, zerebrale Krampfanfälle, Erbrechen, Apnoen, Koma und Tod. Das Schütteltrauma ist eine syndromale Diagnose, die mithilfe der typischen Symptomkonstellation, der Fundoskopie und der zerebralen Bildgebung gestellt wird.

Abstract

Traumatic brain injury, in particular the shaken baby syndrome, leads to significant neurological disability in more than two-thirds of surviving victims and is fatal in 12–27% of cases. It is characterized by a constellation of subdural hematoma and mostly marked retinal hemorrhaging with severe diffuse brain injury, usually without external signs of injuries. Shaken baby syndrome resulting in significant brain damage requires extensive, violent shaking of a child leading to uncontrolled rotation of the head. The resulting subdural and retinal hemorrhages are, however, not important for the prognosis. The combination of diffuse axonal injury and initial traumatic apnea leading to hypoxia, ischemia and intracranial hypertension is assumed to be responsible for the marked brain damage. Clinical symptoms are irritability, feeding problems, somnolence, apathy, cerebral convulsions, vomiting, apnea, coma and death. Shaking injury is a syndromic diagnosis dependant on the total picture of clinical, ophthalmological, radiological and brain imaging features.

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Abbreviations

SBS:

„shaken baby syndrome“ bzw. Schütteltrauma

NAHI:

„non-accidental head injury“ bzw. nichtakzidentelle Kopfverletzungen

SDB:

subdurale Blutungen

RB:

retinale Blutungen

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  1. Ärztliche Kinderschutz- und Kindergynäkologieambulanz, Kinderklinik des Klinikum, Mönchebergstr. 43, 34125, Kassel, Deutschland

    B. Herrmann

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  1. B. Herrmann
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Correspondence to B. Herrmann.

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Herrmann, B. Nichtakzidentelle Kopfverletzungen und Schütteltrauma. Rechtsmedizin 18, 9–16 (2008). https://doi.org/10.1007/s00194-007-0482-7

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