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Diagnostik und Therapie von Schädel-Hirn-Traumen

Diagnosis and treatment of traumatic brain injury

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Zusammenfassung

Das Schädel-Hirn-Trauma (SHT) ist noch immer die Haupttodesursache der unter 45-Jährigen und eine Haupttodesursache der Kinder unter 15 Jahre. Die Inzidenz beträgt 332 pro 100.000 Einwohner. Ein SHT ist die Folge einer Gewalteinwirkung auf den Kopf mit/ohne Verletzung des Gehirns, aber mit zumindest kurzfristiger neurologischer Störung. Alle anderen Verletzungen des Kopfes werden Schädelprellung genannt. Die Schwere eines SHT wird bedingt durch die Dauer der Bewusstlosigkeit. Patienten mit einem SHT sollten stationär überwacht werden. Patienten, die nicht bewusstlos waren und bei der Untersuchung einen GCS (Glasgow Coma Scale) von 15 haben, können ggf. nach Hause entlassen werden, falls dort eine Überwachung gewährleistet ist. Patienten mit einem GCS <15 oder Risikofaktoren müssen mittels CT untersucht und stationär überwacht werden. Akut-lebensbedrohliche, d. h. raumfordernde Blutungen müssen sofort operiert werden. Epidurale oder subdurale Blutungen stellen noch immer, insbesondere beim komatösen Patienten, eine vitale Bedrohung dar und sind somit Op-Indikationen mit absoluter Dringlichkeit.

Abstract

Traumatic brain injury (TBI) is still the major cause of death under 45 years of age and an important one for children under 15. Its incidence is 332/100,000 inhabitants. It results from an impact with the skull with/without lesion of the brain but at least a short-term neurological disorder. All other injuries to the skull should be called concussion. The duration of unconsciousness defines the severity of TBI. Patients with TBI should be admitted to a surgical ward. Those retaining consciousnes and with GCS scores of 15 might be allowed to go home if under surveillance. With GCS of <15 or with risk factors, TBI requires a CT scan and in-hospital surveillance. Acutely life-threatening i.e. space-occupying bleeding must be operated on immediately. Epidural or subdural bleeding, especially in comatose patients, is still a vital risk and thus requires immediate surgery.

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  1. Bereich Neurochirurgie, AKH Celle, Siemensplatz 1, 29223, Celle, Deutschland

    E. Rickels

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  1. E. Rickels
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Rickels, E. Diagnostik und Therapie von Schädel-Hirn-Traumen. Chirurg 80, 153–164 (2009). https://doi.org/10.1007/s00104-008-1655-y

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