Traumatic brain injury

Epidural (nicht sehr verlässlich)

Parenchymal (teuer, geringere Infektionsgefahr als Ventrikelsonde)

Ventrikulär (hohe Infektgefahr)

zeigt Vasospasmen bevor sie klinisch relevant werden

ICP<20

CPP>70

siehe Algorhythmus

30 -35 mmHg oder 5 kPa

Wenn Serum-Osmolarität 30 mOmol übersteigt

0.3mg/kg KG

Contraindications are primary brain-stem injury or established signs of herniation

The usual dose of this drug is 1000mg in the first 24 hours,

500-750mg in the second 24 hours

then 250-300mg per day as indicated by the plasma level

nicht schneller als 25mg/h(kardiotoxisch)

• Reduction in catabolic effects
• Maintenance of immunological competence
• Improvement in CNS regeneration and repair
• Better outcome

Zentraler oder neurogener Diabetes insippidus

Diagn.:

•  Urine output >30 ml/kg BW/h
• specific gravity 1,001 - 1,005
• osmolality 50 - 150mOsmol/kg
• In patients with osmotic diuresis the urine specific gravity and urine osmolality are usually higher.

Osmotische Diurese durch Mannitol

In patients with osmotic diuresis the urine specific gravity and urine osmolality are usually higher.

bis 4000ml/d durch Ersatz

darüber Gabe von Minirin(Desmopressin)

CSF findings include

• elevated protein (>100-500 mg/dl)
• decreased glucose (<50 mg/dl)
• elevated white blood cell count (>10,000/m3)
  • with leukocytosis (>75%).

pulsating exophthalmus and chemosis.

sound of the fistula can be heard by a stethoscope pressed onto the temporal region.

Transcranial doppler

cerebral angiography

• the patient's age
• the depth and duration of post-traumatic coma
• the nature and extent of intracranial and extracranial damage
• the general medical health and previous state of function
• the quality of available clinical care

Hypertonie und Bradykardie bei Herniation

Teufelskreis: Hoher ICP->zur Steigerung des CPP erfolgt reflektorische Steigerung des Blutdrucks->dadurch Steigerung des ICP->Blutdrucksteigerung->usw.

• compression of the paramesencephalic cisterns (pupillary dilation on the side of the haematoma).

Bezeichnung für fokale Läsionen:

Extra-axial lesions are found outside the brain parenchyma and include subdural and epidural haematoma.

Intra-axial lesions include haemorrhagic contusion and traumatic intracerebral haematoma.

in the epidural space between the inner side of the skull and the dura mater.

In most cases the cause is a skull fracture crossing the middle meningeal artery or its branches in the fronto-temporal region.

Selten Venen

 inner side of the dura and the arachnoid layer

It occurs if a cortical vessel is torn

akut: innerhalb der ersten 24h

subakut: 1-7 Tage

am Anfang Bewusstseinsstörung, nach 2-4 Tagen Verschlechterung

>25ccm intrazerebrale Blutung

 disruption and subsequent bleeding of small vessels within the brain tissue

Blutet in den Folgetagen nach!

Eine Subarachnoidalblutung ist eine arterielle Blutung in den Subarachnoidalraum. Ursache ist meist die Ruptur eines intrakraniellen Aneurysmas oder seltener, eines Angioms.

Nach Hunt and Hess

• A focal lesion in the corpus callosum, often associated with traumatic intra- ventricular haemorrhage
• Focal lesions in the brain-stem
• Microscopically widespread damage to axons, often associated with scattered small haemorrhages and mainly located along or near the midline.

Vasogen

Zytotoxisch

Intersitiell

Vasogen:

zytotoxisch:

Interstitiell: