Zusammenfassung
Konvulsionen nach Schädel-Hirn-Traumata (SHT) stellen eine differenzialdiagnostische
und therapeutische Herausforderung dar. Sie können eingeteilt werden in späte (> 7
Tage nach Trauma), frühe (1 – 7 Tage nach Trauma), sofortige (innerhalb der ersten
24 Stunden nach Trauma) oder unmittelbare Konvulsionen („Aufprallanfälle“, innerhalb
der ersten Sekunden nach Trauma). Aufprallanfälle sind möglicherweise nicht epileptischer
Genese und werden auch als kommotionelle Konvulsion bezeichnet. Während frühe und
späte posttraumatische epileptische Anfälle häufig Indikatoren für strukturelle traumatische
Hirnschäden darstellen und mit der Entstehung einer posttraumatischen Epilepsie assoziiert
sind, ist die Datenlage für sofortige Anfälle und insbesondere für Aufprallanfälle
respektive kommotionelle Konvulsionen weniger homogen. Nur ein kleiner Teil sofortiger
Anfälle ist mit strukturellen Hirnschäden und der Entwicklung einer symptomatischen
Epilepsie verbunden, in der Mehrzahl der Fälle handelt es sich um benigne und prognostisch
günstige Ereignisse. Der hier dargestellte Fall dient als Ausgangspunkt für pathophysiologische
und klinische Überlegungen bei unmittelbar nach einem SHT auftretenden Konvulsionen.
Abstract
Convulsions following traumatic brain injury (TBI) represent a diagnostic and therapeutic
challenge. They can be differentiated into late (> 7 days after TBI), early (1 – 7
days after TBI), immediate (within the first 24 h after TBI), and impact seizures
(within seconds after TBI). Some authors suggest that most impact seizures are non-epileptic
in origin and hence coined the term “concussive convulsions” for benign impact seizures.
Early and late post-traumatic seizures frequently indicate structural brain damage
and transition to chronic, post-traumatic epilepsy. The data for impact seizures or
concussive convulsions is less clear: only a small percentage of impact seizures is
associated with structural brain damage and the development of post-traumatic epilepsy,
rather the majority of cases are benign and associated with an excellent prognosis.
Here, we present a case report as a starting point for pathophysiological and clinical
considerations regarding convulsions that start within seconds after TBI.
Schlüsselwörter
Schädel-Hirn-Trauma - Epilepsie - kommotionelle Konvulsionen - Aufprallanfälle
Keywords
epilepsy - traumatic brain injury - concussive convulsions - impact seizures
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Dr. Lothar Burghaus
Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
Kerpener Str. 62
50924 Köln
eMail: lothar.burghaus@uk-koeln.de
