Hypoxisch-ischämische Enzephalopathie

Zusammenfassung

Diese Übersicht beschreibt die Pathophysiologie und Nosologie der hypoxisch-ischämischen Hirnschädigung. Nach einer kurzen Einführung in die Mechanismen des hypoxischen neuronalen Zelltods werden die verschiedenen Möglichkeiten zur Einschätzung der Prognose insbesondere nach Reanimationen unter klinischen und zusatzdiagnostischen Gesichtspunkten für die Perakutphase und an den folgenden Tagen erörtert. Am sichersten ist eine Prognose zu stellen anhand serieller klinischer-neurologischer Untersuchung und somatosensibel evozierten Potenzialen. Zwei unabhängige Studien zeigten aktuell den therapeutischen Nutzen einer Behandlung mit moderater Hypothermie nach Reanimation.

Abstract

This article reviews the pathophysiology and clinical course of anoxic brain damage. A short introduction into the mechanisms of hypoxic neuronal death is given. Clinical, brain imaging, biochemical, and electrophysiological parameters of the hyperacute period as well as during the following days are discussed especially with respect to outcome prediction after cardiopulmonary resuscitation. Most useful parameters are derived from serial clinical neurologic examination and from somatosensory evoked potentials. Recently, two clinical studies showed benefit from treatment with moderate hypothermia after cardiopulmonary resuscitation.

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