Download PDF
Krankenhauspsychiatrie 2002; 13(2): 65-70
DOI: 10.1055/s-2002-32109
Weiterbildung
© Georg Thieme Verlag Stuttgart · New York

Das milde Hirntrauma

Diagnostische, pathogenetische und therapeutische AspekteThe Mild Traumatic Brain Injury Diagnostic, Pathogenetic and Therapeutic IssuesT.  Knecht1
  • 1Psychiatrische Klinik Münsterlingen, Schweiz
Further Information

Publication History

Publication Date:
07 June 2002 (online)

    Permissions and Reprints

Zusammenfassung

Milde Schädel-Hirn-Traumata können sowohl unter therapeutischem als auch unter gutachterlichem Aspekt erhebliche Probleme aufwerfen. Die traditionelle Auffassung, wonach eine Commotio cerebri praktisch immer ohne spezifische Therapie ad integrum ausheilt, kann nicht in jedem Fall aufrecht erhalten werden. Der Autor zeigt die multifaktorielle Genese dieser Störungsbilder mit den charakteristischen Komplikationsmöglichkeiten auf. Dabei wird auch der Stellenwert der verschiedenen diagnostischen Verfahren erläutert. Schließlich wird noch auf neuere Therapieansätze hingewiesen.

Abstract

Mild brain injuries can be a major problem under diagnostic as well as under therapeutic aspects. The traditional opinion that a postconcussive symptomatology can be expected to recover in all cases even without specific treatment cannot be upheld. The author outlines the multifactorial genesis of the sequels to mild brain injuries including the typical complications. Further, the value of the different diagnostic procedures will be discussed and conventional and novel therapeutic approaches will be described.

Schlüsselwörter

Mildes Hirntrauma - Diagnostik - Pathogenese - Behandlung

Key words

Mild traumatic brain injury - diagnosis - pathogenesis - treatment

Literatur

  • 1 Abdel-Dayem H M, Abu-Judeh H, Kumar M, Atay S, Naddaf S, El-Zeftawy H, Luo J Q. SPECT brain perfusion abnormalities in mild or moderate traumatic brain injury.  Clin Nucl Med. 1998;  23 309-317
    CrossrefGoogle Scholar
  • 2 Abu-Judeh H H, Parker R, Singh M, El-Zeftawy H, Atay S, Kumar M, Naddaf S, Aleksic S, Abdel-Dayem H M. SPECT brain perfusion imaging in mild traumatic brain injury without loss of conscionsness and normal computed tomography.  Nucl Med Commun. 1999;  20 505-510
    Google Scholar
  • 3 Borczuk P. Mild head trauma.  Emerg Med Clin North Am. 1997;  15 563-579
    Google Scholar
  • 4 Brooks J, Fos L A, Greve K W, Hammond J S. Assessment of executive function in patients with mild traumatic brain injury.  Journal of Trauma-Injury Infection and Critical Care. 1999;  46 159-163
    Google Scholar
  • 5 Bryant R A, Harvey A G. Relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury.  Am J Psychiatry. 1998;  155 625-629
    Google Scholar
  • 6 Bryant R A, Harvey A G. Postconcussive symptoms and posttraumatic stress disorder after mild traumatic brain injury.  J Nerv Ment Dis. 1999;  187 302-305
    CrossrefGoogle Scholar
  • 7 Busch C R, Alpern H P. Depression after mild traumatic brain injury: a review of current research.  Neuropsychology Review. 1998;  8 95-108
    CrossrefGoogle Scholar
  • 8 Cercy S P, Shretlen T, Brtandt J. Simulated amnesia and the pseudo-memory-phenomena. In: Rogers R (ed) Clinical assessment of malingering and deception. Guilford Press New York; 1997
    Google Scholar
  • 9 Chambers J, Cohen S S, Hemminger L, Prall J A, Nichols J S. Mild traumatic brain insuries in low-risk trauma patients.  Journal of Trauma-Injury, Infection and Critical Care. 1996;  41 976-980
    Google Scholar
  • 10 Chapman E H, Weintraub R J, Milburn M A, Pirozzi T O, Woo E. Homeopathic treatment of mild traumatic brain injury: a randomized, double-blind placebo-controlled clinical trial.  Journal of Head Trauma Rehabilitation. 1999;  14 521-542
    Google Scholar
  • 11 Clark R S, Kochanek P M, Dixon C E, Chen M, Marion D W, Heinemann S, Dekosky S T, Graham S H. Early neuropathologic effects of mild hypoxemia after controlled cortical impact injury in rats.  J Neurotrauma. 1997;  14 179-189
    Google Scholar
  • 12 Fann J R, Uomoto J M, Katan W J. Sertraline in the treatment of major depression following mild traumatic brain injury.  J Neuropsychiatr Clin Neruosci. 2000;  12 226-232
    Google Scholar
  • 13 Fann J R, Uomoto J M, Katan W J. Cognitive improvement with treatment of depression following mit traumatic brain injury.  Psychosomatics. 2001;  42 48-54
    CrossrefGoogle Scholar
  • 14 Gorbunov V I. A clinico-immunulogical study in recurrent mild craniocerebral trauma in the acute period.  Zhurnal Voprosy Neirokhirurgii Imeni N-N-Burdenko. 1999;  2 17-21
    Google Scholar
  • 15 Gross H, Kling A, Henry G, Hemdon C, Lavretsky H. Local cerebral glucose metabolism in patients with long time behavioral and cognitive deficits following mild traumatic brain injury.  J Neuropsychiatr Clin Neurosci. 1996;  8 324-334
    Google Scholar
  • 16 Keel P. Die Beurteilung psychischer Unfallfolgen: Wenn Befund und Befinden nicht übereinstimmen. In: Zangger P, Erb-Egli D (Hrsg) Die verunfallte Psyche - psychische Schäden als Unfallfolge. Elster Zürich; 1999: 133-160
    Google Scholar
  • 17 Krüger J, Vogt J, Stappenbeck C, Schaaf C, Pressler M. EEG, CCT und MRT bei Patienten nach leichtem und mittelschwerem Schädel-Hirn-Trauma - Eine Untersuchung bei 102 Patienten.  Nervenarzt. 1991;  62 226-231
    Google Scholar
  • 18 Lankford D A, Wellman J J, O’Hara C. Posttraumatic narcolepsy in mild to moderate closed head injury.  Sleep. 1994;  17 25-28
    Google Scholar
  • 19 Martelli M F, Zasler N D, Mac Millan P. Mediating the relationship between injury, impairment and disability: A vulnerability, stress and coping model of adaptation following brain injury.  Neuro Rehabilitation. 1998;  11 51-56
    Google Scholar
  • 20 Martelli M F, Grayson R L, Zasler N D. Posttraumatic hedache: Neuropsychological and psychological effects and treatment implications.  J Head Trauma Rehabil. 1999;  14 49-69
    Google Scholar
  • 21 Mathias J L, Coats J L. Emotional and cognitive sequelae to mild traumatic brain injury.  J Clin Exp Neuropsychol. 1999;  21 200-215
    Google Scholar
  • 22 Mc Allister T W, Saykin A J, Flashman L A, Sparling M B, Johnson S C, Geurin S J, Mamorian A C, Weaver J B, Yanofsky N. Brain activation during working memory 1 month after mild traumatic brain injury: a functional MRI study.  Neurology. 1999;  53 1300-1308
    CrossrefGoogle Scholar
  • 23 Meerhoff S R, de Kruijk J R, Rutten J, Feffers P, Twijnstra A. Indidence of traumatic head or brain injuries in catchment area of Academic Hospital Maastricht in 1997.  Ned Tijdschr Geneeskd. 2000;  144 1915-1918
    Google Scholar
  • 24 Merchant R E, Bullock M R, Carmack C E, Schah A K, Wilner K D, Williams S A. A double-blind placebo-controlled study of the safety, tolerability and pharmacokinetics of CP 101, 606 in patients with a mild or moderate traumatic brain injury.  Ann NY Acad Sci. 1999;  890 42-50
    Google Scholar
  • 25 Meyers J E, Galinsky A M, Volbrecht M. Malingering and mild brain injury: how low is too low?.  Applied Neuropsychology. 1999;  6 208-216
    Google Scholar
  • 26 Meyers J E, Volbrecht M. Detection of malingerers using the Rey Complex Figure and Recognition Trial.  Appl Neuropsychol. 1999;  6 201-207
    Google Scholar
  • 27 Nell V, Yates D W, Kruger J. An extended Glasgow Coma Scale (GCS-E) with enhanced sensitivity to mild brain injury.  Arch Phys Med and Rehabil. 2000;  81 614-617
    Google Scholar
  • 28 Palmese C A, Raskin S A. The rehabilitation of attention in individuals with mild traumatic brain injury, using the APT-III programme.  Brain Injury. 2000;  14 535-548
    CrossrefPubMedGoogle Scholar
  • 29 Ponsford J, Willmott C, Rothwell A, Cameron P, Kelly A M, Nelms R, Curran C, Ng K. Factors influencing outcome following mild traumatic brain injury in adults.  J Int Neuropsychol Soc. 2000;  6 568-579
    CrossrefPubMedGoogle Scholar
  • 30 Quinn B, Sullivan S J. The identification by physiotherapists of the physical problems resulting from a mild traumatic brain injury.  Brain Injury. 2000;  14 1063-1076
    CrossrefGoogle Scholar
  • 31 Radanov B. Die Basis der kognitiven Störungen - eine Kontroverse. In: Zangger P, Erb-Egli D (Hrsg) Die verunfallte Psyche - psychische Schäden als Unfallfolge. Elster Zürich; 1999: 71-86
    Google Scholar
  • 32 Raskin S A. The relationship between sexual abuse and mild traumatic brain injury.  Brain Injury. 1997;  11 587-603
    CrossrefGoogle Scholar
  • 33 Scheid W. Lehrbuch der Neurologie. 4. Aufl Thieme Stuttgart; 1980: 445
    Google Scholar
  • 34 Stewart J A, Tannock R. Inhibitory control differences following mild head injury.  Brain and Cognition. 1999;  41 411-416
    CrossrefGoogle Scholar
  • 35 Strebel S, Lam A M, Matta B F, Newell D W. Impaired cerebral autoregulation after mild brain injury.  Surg Neurol. 1997;  47 128-131
    Google Scholar
  • 36 Sturmi J E, Smith C, Lombardo G A. Mild brain trauma in sports. Diagnosis and treatment guidelines.  Sports Med. 1998;  25 351-358
    Google Scholar
  • 37 Todd D D. Kinesiophobia: The relationship between chronic pain and feat-induced diability.  Forensic Examine. 1998;  7 14-20
    Google Scholar
  • 38 van der Naalt J, Hew J M, van Zomeren A H, Sluiter W J, Minderhoud J M. Computed tomography and magnetic resonance imaging in mild to moderate head injury: early and late imaging related to outcome.  Ann of Neurol. 1999;  46 70-78
    Google Scholar
  • 39 van der Naalt J, van Zomeren A H, Sluiter W J, Minderhoud J M. One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work.  J Neurol Neurosurg Psychiatry. 1999;  66 207-213
    Google Scholar
  • 40 van der Naalt J, van Zomeren A H, Sluiter W J, Minderhoud J M. Acute behavioral disturbances related to imaging studies and outcome in mild-to-moderate head injury.  Brain Injury. 2000;  14 781-788
    CrossrefGoogle Scholar
  • 41 Veltman R H, Van Dongen S, Jones S, Buechler C M, Blostein P. Cognitive Screening in mild brain injury.  J Neurosci Nurs. 1993;  25 367-371
    Google Scholar
  • 42 Werner C. Mild and moderate hypothermia as a new therapy concept in treatment of cerebral ischemia and craniocerebral trauma Pathophysiologic principles.  Anästhesiol Intensivmed Notfallmed Schmerzther. 1997;  32 210-218
    Google Scholar
  • 43 Ziegler D K, Paolo A M. Hedache symptoms and psychological profile of headache - prone individuals: A comparison of clinic patients and controls.  Arch Neurol. 1995;  52 602-606
    Google Scholar

Leitender Arzt Dr. med. T. Knecht

Psychiatrische Klinik

8596 Münsterlingen

Schweiz