Korrekte Voraussage eines sehr guten Outcomes nach Schädel-Hirn-Trauma durch multimodale EP bei klinisch und neuroradiologisch infaust erscheinendem Befund
Multimodal EP Correctly Predicts a Favourable Outcome of Severe Skull-Brain Trauma Following Unpromising Clinical and Neuroradiological FindingsM. Gelzenlichter 1
, E. Maurer 1
, P. Milewski 1
, J. Nothwang 2
1Abteilung für Anästhesie, Klinik am Eichert, Göppingen
2Abteilung für Unfallchirurgie, Klinik am Eichert, Göppingen
Vorgestellt wird der ungewöhnlich positive Verlauf eines schweren Schädel-Hirn-Traumas mit epiduraler Blutung und konsekutiver subtotaler oberer Einklemmung. Trotz infaust erscheinenden klinischen und neuroradiologischen Befunden, zeigten sich in den wiederholt abgeleiteten somatosensorisch evozierten Potenzialen (SEP) immer erhaltene Skalpantworten, und auch in den frühen akustisch evozierten Potenzialen (FAEP) waren stets alle fünf Peaks nachweisbar. Somit konnte eine mögliche Erholung des Zerebrums vorhergesagt werden. Der klinischen Besserung ging eine sukzessive Erholung der anfangs verzögerten kortikalen SEP-Antworten voraus. Multimodal evozierte Potenziale sind in der Lage, trotz klinisch infaust erscheinender Prognose ein gutes Outcome korrekt vorherzusagen. Sie sind bei schweren Verletzungen des ZNS als Standardmonitoring geeignet, zumal es sich um eine wenig aufwändige und schnell erlernbare nichtinvasive Methode handelt.
Abstract
Unusual positive outcome of severe skull-brain trauma with epidural bleeding and consecutive subtotal supratentorial hemiation is presented. Despite unfavourable clinical and neuroradiological findings, repeatedly measured SEPs consistently showed electric scalp potentials. Early acustically evoced potentials also always showed all 5 peaks. This enabled a prediction of positive cerebral outcome. The slow recovery of initial prolonged cortical SEPs preceeded clinical recovery. Multimodal evoked potentials enable us, inspite of, adverse clinical findings, to predict a promising outcome correctly. SEP can be used as easily implemented, quickly learned and non-invasive standard monitoring of severe trauma of the CNS.
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