Download PDF
Notfallmedizin up2date 2007; 2(2): 121-137
DOI: 10.1055/s-2007-965261
Spezielle Notfallmedizin

© Georg Thieme Verlag KG Stuttgart · New York

Schädel-Hirn-Trauma

Christof Renner, Jürgen Meixensberger
Further Information

Publication History

Publication Date:
26 October 2007 (online)

Also available at
    Permissions and Reprints All articles of this category

Kernaussagen

Neben dem primären Hirnschaden infolge der direkten Gewalteinwirkung stellt der sekundäre Hirnschaden als Folge von Hypotonie und Hypoxie das Zentrum der therapeutischen Bemühungen dar. Die schnellstmögliche Sicherstellung einer suffizienten Kreislaufsituation mit einem resultierenden CPP (> 60 mmHg), einem kontrollierten ICP (< 20 mmHg) und der schnellstmöglichen Beseitigung chirurgisch behandelbarer hirndruckerhöhender Raumforderungen führen zu einer deutlichen Senkung des Morbiditäts- und Mortalitätsrisikos. Zur Behandlung eines chirurgisch nicht zu therapierenden erhöhten Hirndrucks steht ein eskalierendes Stufenschema zur Verfügung.

Literatur

  • 1 Bardenheuer M, Obertacke U, Waydhas C, Nast-Kolb D. Epidemiologie des Schwerverletzten.  Unfallchirurg. 2001;  103 355-363
    Google Scholar
  • 2 Teasdale G, Jennett B. Assessment of coma and impaired consciousness.  Lancet. 1974;  1 81
    Google Scholar
  • 3 Wenzlaff P. Ergebnisse. Rickels E, von Wild K, Wenzlaff P, Bock WJ (Hrsg.) Schädel-Hirn-Verletzung, Epidemiologie und Versorgung, Ergebnisse einer prospektiven Studie. München; Zuckschwerdt 2006: 42-74
    Google Scholar
  • 4 Chesnut R M, Marshall S B, Piek J, Blunt B A, Klauber M R, Marshall L F. Early and late systemic hypotension as a frequent and fundamental source of cerebral ischaemia following severe brain injury in the Traumatic Coma Data Bank.  Acta Neurochir. 1993;  59 (Suppl) 121-125
    Google Scholar
  • 5 Watts D D, Hanfling D, Waller M, Gilmore C, Fakhry S M, Trask A L. An evaluation of the use of guidelines in prehospital management of brain injury.  Prehospital Care. 2004;  8 254-261
    Google Scholar
  • 6 Itshayek E, Rosenthal G, Fraifeld S, Perez-Sanchez X, Cohen J E, Spektor S. Delayed posttraumatic acute subdural hematoma in elderly patients on anticoagulation.  Neurosurgery. 2006;  58 E851-856
    CrossrefGoogle Scholar
  • 7 Oertel M, Kelly D F, McArthur D. et al . Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury.  J Neurosurg. 2002;  96 109-116
    CrossrefPubMedGoogle Scholar
  • 8 Koc R, Akdemir H, Okten I S, Meral M, Menku A. Acute subdural hematoma: outcome and outcome prediction.  Neurosurg Rev. 1997;  20 239-244
    CrossrefGoogle Scholar
  • 9 Englander J, Bushnik T, Duong T. et al . Analyzing risk factors for late posttraumatic seizures: a prospective multicenter investigation.  Arch Phys Med Rehabil. 2003;  84 365-373
    CrossrefPubMedGoogle Scholar
  • 10 D'Ambrosio R, Perucca E. Epilepsy after head injury.  Curr Opin Neurol. 2004;  17 731-735
    CrossrefGoogle Scholar
  • 11 Baethmann A, Kempski O, Unterberg A. Entstehung und Therapie zerebraler Sekundärschäden.  Münch Med Wschr. 1982;  43 941-944
    Google Scholar
  • 12 Marmarou A, Anderson Rl, Ward J D. Impact of ICP instability and hypotension on outcome in patients with severe head trauma.  J Neurosurg. 1991;  75 59-66
    Google Scholar
  • 13 Lang E, Lagopoulos J, Griffith J. et al . Cerebral vasomotor reactivity testing in head injury: the link between pressure and flow.  JNNP. 2003;  74 1053-1059
    CrossrefGoogle Scholar
  • 14 Rosner M J, Rosner S D, Johnson A H. Cerebral perfusion pressure: management protocol and clinical results.  J Neurosurg. 1995;  83 949
    CrossrefGoogle Scholar
  • 15 Contant C F, Valadka A B, Gopinath S P, Hannay H J, Robertson C S. Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury.  J Neurosurg. 2001;  95 560-568
    CrossrefGoogle Scholar
  • 16 Lang E, Czosnyka M, Mehdorn M. Tissue oxygen reactivity and cerebral autoregulation after severe traumatic brain injury.  Crit Care Med. 2003;  31 267-271
    CrossrefGoogle Scholar
  • 17 Cremer O L, van Dijk G W, Ameklink G J, de Smet A M, Moons K G, Kalkman C J. Cerebral hemodynamic responses to blood pressure manipulation in severely head-injured patients in the presence or absence of intracranial hypertension.  Anesth Analg. 2004;  99 1211-1217
    Google Scholar
  • 18 Meixensberger J, Jaeger M, Väth A, Dings J, Kunze E, Roosen K. Brain tissue oxygen guided treatment supplementing ICP/CPP therapy after traumatic brain injury.  J Neurol Neurosurg Psych. 2003;  74 760-764
    Google Scholar
  • 19 Jaeger M, Soehle M, Schuhmann M U, Winkler D, Meixensberger J. Correlation of continuously monitored regional cerebral blood flow and brain tissue oxygen.  Acta Neurochir. 2005;  147 51-56
    CrossrefGoogle Scholar
  • 20 Lundberg N. Continuous recording and control of ventricular fluid pressure in neurosurgical practice.  Acta Psychiatr Neurol Scand. 1960;  36 (Suppl 149) 191-193
    Google Scholar
  • 21 Schneider G H, von Helden G H, Franke R, Lanksch W R, Unterberg A. Influence of body position on jugular venous oxygen saturation, intracranial pressure and cerebral perfusion pressure.  Acta Neurochir. 1993;  59 (Suppl) 107-112
    Google Scholar
  • 22 Maas A I, Dearden M, Teasdale G M. et al . EBIC‐guidelines for management of severe head injury in adults. European Brain Injury Consortium.  Acta Neurochir. 1997;  139 286-294
    CrossrefGoogle Scholar
  • 23 Sanchez-Izquierdo-Riera J A, Caballero-Cubedo R E, Perez-Vela J L, Ambros Checa A, Cantalapiedra-Santiago J A, Alted-Lopez E. Propofol versus midazolam: safety and efficacy for sedating the severe trauma patient.  Anesth Analg. 1998;  86 1219-1224
    CrossrefPubMedGoogle Scholar
  • 24 Albanese J, Viviand X, Potie F, Rey M, Alliez B, Martin C. Sufentanil, fentanyl and alfentanil in head trauma patients: a study on cerebral hemodynamics.  Crit Care Med. 1999;  27 407-411
    CrossrefGoogle Scholar
  • 25 Schwartz M L, Tator C H, Rowed D W. et al . The University of Toronto head injury treatment study: a prospective, randomized comparison of pentobarbital and mannitol.  Can J Neurol Sci. 1984;  11 434-440
    Google Scholar
  • 26 Schatzmann C, Heissler H E, König K. et al . Treatment of elevated intracranial pressure by infusions of 10 % saline in severely head injured patients.  Acta Neurochir Suppl . 1998;  71 31-33
    Google Scholar
  • 27 Imberti R, Bellinzona G, Langer M. Cerebral tissue PO2 and SjvO2 changes during moderate hyperventilation in patients with severe traumatic brain injury.  J Neurosurg. 2002;  96 97-102
    CrossrefGoogle Scholar
  • 28 Roberts I. Barbiturates for acute traumatic brain injury.  The Cochrane Database of systematic reviews. 1999;  Issue 3 Art. No. CD 000033
    Google Scholar
  • 29 Poldermann K H. Application of therapeutic hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality. Part I: Indications and evidence.  Intensive Care Med. 2004;  30 556-575
    CrossrefGoogle Scholar
  • 30 Clifton G L, Miller E R, Choi S C. et al . Lack of effect of induction of hypothermia after acute brain injury.  N Engl J Med. 2001;  344 556-563
    CrossrefPubMedGoogle Scholar
  • 31 Jaeger M, Soehle M, Meixensberger J. Improvement of brain tissue oxygen and intracranial pressure during and after surgical decompression for diffuse brain edema and space occupying infarction.  Acta Neurochir Suppl . 2005;  95 117-118
    Google Scholar

Dr. med. Christof Renner Ltd. Oberarzt

Klinik und Poliklinik für Neurochirurgie

Liebigstraße 20

04103 Leipzig

Phone: 03 41/9 71 75 25

Fax: 03 41/9 71 75 09

Email: Christof.Renner@medizin.uni-leipzig.de