Download PDF
Fortschr Neurol Psychiatr 2013; 81(9): 511-522
DOI: 10.1055/s-0033-1350374
Begutachtung
© Georg Thieme Verlag KG Stuttgart · New York

Die Leitlinie „Begutachtung nach gedecktem Schädel-Hirntrauma“

The German Guideline “Legal Evaluation after Closed Head Injury”
C. W. Wallesch
1   Klinik für Neurologische Rehabilitation, BDH-Klinik Elzach GmbH, Elzach
,
W. Fries
2   Neurokompetenz GmbH, München
,
P. Marx
3   Terrassenstr.45, Berlin
,
R. du Mesnil de Rochemont
4   Institut für Neuroradiologie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt
,
R. Roschmann
5   Abteilung Psychologie, Klinikum Ingolstadt
,
R. Schmidt
6   Psychosomatische Neurologie, Kliniken Schmieder, Konstanz
,
K. Schwerdtfeger
7   Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar
,
M. Tegenthoff
8   Neurologische Klinik und Poliklinik, BG-Universitätsklinikum Bergmannsheil, Bochum
,
B. Widder
9   Klinik für Neurologie und Neurologische Rehabilitation, Bezirkskrankenhaus Günzburg
› Author Affiliations
Further Information

Publication History

Publication Date:
28 August 2013 (online)

    Permissions and Reprints

Zusammenfassung

Die Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung, damals noch Arbeitsgemeinschaft neurologische Begutachtung, hat 2005 gemeinsam mit anderen Fachgesellschaften erstmals eine Leitlinie zur Begutachtung nach gedecktem Schädel-Hirntrauma erarbeitet und publiziert[1]. In der Zwischenzeit hat es weitreichende Fortschritte in der Bildgebung, aber auch z. B. in der neuropsychologischen Diagnostik gegeben. Diese machten eine Überarbeitung der Leitlinie notwendig, die hier vorgestellt wird. Zwischenzeitlich ist der Umgang mit Leitlinien in Deutschland systematisiert worden, sodass die neue Version der Leitlinie im Leitlinienregister der Arbeitsgemeinschaft Medizinischer Fachgesellschaften angemeldet wurde und dort publiziert werden soll.

Abstract

In 2005, the “Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung” (German Society for Neuroscientific Legal Evaluation) together with other Societies published a guideline for the legal evaluation of patients with closed head injuries1. Meanwhile, not only scientific progress in imaging techniques but also in other fields such as neuropsychology has necessitated a revision, which is presented here. In the mean time, the handling of guidelines has been systematised in Germany so that a registration with the Cooperation of German Medical Learned Societies is applied for and publication in the German Guideline Registry is expected.

Schlüsselwörter

Schädel-Hirntrauma - Begutachtung - Neuroradiologie - Neuropsychologie - Neurologie - Neurochirurgie

Key words

closed head injury - evaluation - neuroradiology - neuropsychology - neurology - neurosurgery

1 Literatur: Wallesch CW, Marx P, Tegenthoff M, Unterberg A, Schmidt R, Fries W. Leitlinie „Begutachtung nach gedecktem Schädel-Hirntrauma“. Akt Neurol 2005; 32: 279 – 287.


 

  • Literatur

  • Andriessen TM, Jacobs B, Vos BE. Clinical characteristics and pathophysiological mechanisms of focal and diffuse traumatic brain injury. J Cell Mol Med 2010; 14: 2381-2392
    CrossrefPubMedGoogle Scholar
  • Angeleri F, Majkowski J, Cacchio G et al. Posttraumatic epilepsy risk factors: one-year prospective study after head injury. Epilepsia 2002; 40: 1222-1230
    PubMedGoogle Scholar
  • Annegers JF, Hauser WA, Coan SP et al. A population-based study after traumatic brain injury. N Engl J Med 1998; 338: 20-24
    CrossrefPubMedGoogle Scholar
  • Annegers JF, Grabow JD, Groover RV et al. Seizures after head trauma: A population study. Neurology 1980; 30: 683-689
    CrossrefPubMedGoogle Scholar
  • Arciniegas DB, Anderson CA. Suicide in neurological illness. Curr Treatm Opt Neurol 2002; 4: 457-468
    PubMedGoogle Scholar
  • Azouvi P. Neuroimaging correlates of cognitive and functional outcome after traumatic brain injury. Corr Opin Neurol 2000; 134: 665-669
    PubMedGoogle Scholar
  • Barkhoudarian G, Hovda DA, Giza CC. The molecular pathophysiology of concussive brain injury. Clin Sports Med 2011; 30: 33-48
    CrossrefPubMedGoogle Scholar
  • Bavisetty S, McArthur DL et al. Chronic hypopituitarism after traumatic brain injury: risk assessment and relationship to outcome. Neurosurgery 2008; 62: 1080-1093
    CrossrefPubMedGoogle Scholar
  • Barry E, Krumholz A, Bergey GK. Nonepileptic posttraumatic seizures. Epilepsia 1998; 39: 233-238
    CrossrefPubMedGoogle Scholar
  • Bryant RA, Marosszeky JE, Crooks J et al. Posttraumatic stress disorder and psychosocial functioning after severe traumatic brain injury. J Nerv Ment Dis 2001; 189: 109-113
    CrossrefPubMedGoogle Scholar
  • Christensen J, Pedersen MG, Pedersen CB et al. Long-term risk of epilepsy after traumatic brain injury in children and young adults: a population-based cohort study. Lancet 2009  373: 1105-1110
    PubMedGoogle Scholar
  • Deb S, Lyons I, Koutzoukis C et al. Rate of psychiatric illness 1 year after traumatic brain injury. J Psychiatry 1999; 156: 374-378
    PubMedGoogle Scholar
  • Dohrenbusch R, Henningsen P, Merten T. Die Beurteilung von Aggravation und Dissimulation in der Begutachtung psychischer und psychosomatischer Störungen. Versicherungsmedizin 2011; 63: 81-85
    PubMedGoogle Scholar
  • Dombovy ML, Olek AC. Recovery and rehabilitation following traumatic brain injury. Brain Inj 1997; 11: 305-318
    CrossrefPubMedGoogle Scholar
  • Evers S, May A, Heuft G et al. Die Begutachtung von idiopathischen und symptomatischen Kopfschmerzen. Nervenheilkunde 2010; 4: 229-241
    PubMedGoogle Scholar
  • Fork M, Bartels C, Ebert AD et al. Neuropsychological sequelae of diffuse traumatic brain injury. Brain Inj 2005; 19: 101-108
    CrossrefPubMedGoogle Scholar
  • Foerster K, Widder B. Begutachtung psychischer Unfallfolgen. Nervenarzt 2011; 82: 1557-1565
    CrossrefPubMedGoogle Scholar
  • Fröscher W. Anfallsleiden – posttraumatisch oder unfallunabhängig?. Med Sach 2009; 105: 222-227
    PubMedGoogle Scholar
  • Gennarelli TA. Cerebral concussion and diffuse brain injuries. In: Cooper PR, (ed) Head injury. 3rd edn. Baltimore: Williams & Wilkins; 1994: 137-158
    Google Scholar
  • Gennarelli TA, Thibault LE, Adams JH et al. Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 1982; 12: 564-574
    CrossrefPubMedGoogle Scholar
  • Gentry JR, Godersky JC, Thompson B. MR imaging of head trauma: review of the distribution and radiographic features of traumatic brain lesions. Am J Roentgenol 1988; 150: 663-672
    CrossrefPubMedGoogle Scholar
  • Gurdjian ES. Cerebral contusions: re-evaluation of the mechanism of their development. J Trauma 1976; 16: 35-51
    CrossrefPubMedGoogle Scholar
  • Hannay HL, Levin HS, Grossman RG. Impaired recognition memory after head injury. Cortex 1979; 15: 269-283
    CrossrefPubMedGoogle Scholar
  • Hausotter W. Neurologische Begutachtung. 2. Aufl. Stuttgart-New York: Schattauer; 2006
    Google Scholar
  • Hughes DG, Jackson A, Mason DL et al. Abnormalities on magnetic resonance imaging seen acutely following mild traumatic brain injury: correlation with neuropsychological tests and delayed recovery. Neuroradiology 2004; 46: 550-558
    PubMedGoogle Scholar
  • Huisman TAGM, Schwamm LH, Schaefer PW et al. Diffusion tensor imaging as potential biomarker of white matter injury in diffuse axonal injury. Am J Neuroradiol 2004; 25: 370-376
    PubMedGoogle Scholar
  • Huisman TAGM, Sorensen AG, Hergan K et al. Diffusion-weighted imaging for the evaluation of diffuse axonal injury in closed head injury. J Comput Ass Tomogr 2003; 27: 5-11
    CrossrefPubMedGoogle Scholar
  • Jorge RE, Robinson RG, Moser D et al. Major depression following traumatic brain injury. Arch Gen Psychiat 2004; 61: 42-50
    CrossrefPubMedGoogle Scholar
  • Karbowski P, Pavlincova E, Vassella F. Zur Frage einer posttraumatischen Absenzepilepsie. Nervenarzt 1981; 52: 718-722
    PubMedGoogle Scholar
  • Klosterkötter J. Organische und funktionelle psychische Störungen: Konzepte und Entwicklungen. In: Förstl H, (Hrsg.) Klinische Neuro-Psychiatrie. Neurologie psychischer Störungen und Psychiatrie neurologischer Erkrankungen. Stuttgart: Thieme; 2000
    Google Scholar
  • Koponen S, Taiminen T, Portin R et al. Axis I and II psychiatric disorders after traumatic brain injury: a 30-year follow-up study. Am J Psychiatry 2002; 159: 1315-1321
    CrossrefPubMedGoogle Scholar
  • Kumar R, Saksena S, Husain M et al. Serial changes in diffusion tensor imaging metrics of corpus callosum in moderate traumatic brain injury patients and their correlation with neuropsychometric tests: a 2-year follow-up study. J Head Trauma Rehabil 2010; 25: 31-42
    CrossrefPubMedGoogle Scholar
  • Levin HS, High WM, Goethe KE et al. The neurobehavioural rating scale: assessment of the behavioural sequelae of head injury by the clinician. J Neurol Neurosurg Psychiat 1987; 50: 183-193
    CrossrefPubMedGoogle Scholar
  • Lipton ML, Gulko E, Zimmermann ME et al. Diffusion-tensor imaging implicates prefrontal axonal injury in executive function impairment following very mild traumatic brain injury. Radiology 2009; 25: 816-824
    PubMedGoogle Scholar
  • Marx P, Gaidzik PW, Hausotter W et al. Allgemeine Grundlagen der neurologischen Begutachtung. Akt Neurol 2005; 32: 94-101
    Article in Thieme ConnectPubMedGoogle Scholar
  • Mataro M, Poca MA, Sahuquillo J et al. Neuropsychological outcome in relation to the traumatic coma data bank classification of computed tomography imaging. J Neurotrauma 2001; 18: 869-879
    CrossrefPubMedGoogle Scholar
  • Mayer AR, Ling J, Mannell MV et al. A prospective diffusion tensor imaging study in mild traumatic brain injury. Neurology 2010; 74: 643-650
    CrossrefPubMedGoogle Scholar
  • Mazaux JM, Masson F, Levin HS et al. Long-term neuropsychological outcome and loss of social autonomy after traumatic brain injury. Arch Phys Med Rehabil 1997; 78: 1316-1320
    CrossrefPubMedGoogle Scholar
  • Meaney DF, Smith DH. Biomechanics of concussion. Clin Sports Med 2011; 30: 19-31
    CrossrefPubMedGoogle Scholar
  • Messori A, Polonara G, Mabiglia C et al. Is haemosiderin visible indefinitely on gradient-echo MRI following traumatic intracerebral haemorrhage?. Neuroradiology 2003; 45: 881-886
    CrossrefPubMedGoogle Scholar
  • Meythaler JM, Peduzzi JD, Eleftheriou E et al. Current concepts: diffuse axonal injury-associated traumatic brain injury. Arch Phys Med Rehabil 2001; 82: 1461-1471
    CrossrefPubMedGoogle Scholar
  • Mittl RL, Grossman RI, Hiehle JF et al. Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal head CT-findings. AJNR 1994; 15: 1583-1589
    PubMedGoogle Scholar
  • Neumann-Zielke L, Roschmann R, Wilhelm H et al. Neuropsychologische Begutachtung. Akt Neurol 2008; 35: 443-449
    Article in Thieme ConnectPubMedGoogle Scholar
  • Rauschelbach HH. Zur gutachterlichen Beurteilung der traumatischen Epilepsien. Med Sachverst 1977; 73: 86-88
    PubMedGoogle Scholar
  • Ritter G. Schlussbetrachtung und Diskussion. In: Suchenwirth RMA, Ritter G, (Hrsg.) Begutachtung der hirnorganischen Wesensänderung. Stuttgart: Fischer; 1994: 117-122
    Google Scholar
  • Ruff RM. Mild traumatic brain injury and neural recovery: Rethinking the debate. NeuroRehabiitation 2011; 28: 167-180
    PubMedGoogle Scholar
  • Scheid R, Preul C, Gruber O et al. Diffuse axonal injury associated with chronic traumatic brain injury: Evidence from T2*- weighted gradient-echo imaging at 3T. AJNR 2003; 24: 1049-1056
    PubMedGoogle Scholar
  • Schneider HJ, Schneider M, von Rosen F et al. Hypophyseninsuffizienz nach Schädel-Hirn-Trauma. Dtsch Ärztebl 2004; 101: 712-717
    PubMedGoogle Scholar
  • Schönberger A, Mehrtens G, Valentin H. Arbeitsunfall und Berufskrankheit. 8. Aufl. Berlich: Erich Schmidt; 2010
    Google Scholar
  • Schütze M, Dauch WA, Guttinger M. Risikofaktoren für posttraumatische Anfälle und Epilepsie. Zentralbl Neurochir 1999; 60: 163-167
    PubMedGoogle Scholar
  • Spikman JM, Kiers HA, Deelman BG et al. Construct validity of concepts of attention in healthy controls and patients with CHI. Brain Cogn 2001; 47: 446-460
    CrossrefPubMedGoogle Scholar
  • Stuss DT, Ely P, Hugenholtz D. Subtle neuropsychological deficits in patients with good recovery after closed head injury. Neurosurgery 1985; 17: 41-47
    CrossrefPubMedGoogle Scholar
  • Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2: 81-84
    CrossrefPubMedGoogle Scholar
  • Teasdale TW, Skovdahl H, Gade A et al. Neuropsychological test scores before an after brain injury rehabilitation in relation to returns to employment. Neurospychol Rehabil 1997; 7: 23-33
    PubMedGoogle Scholar
  • Toschlog EA, MacElligot J, Sagraves SG et al. The relationship of Injury Severity Score and Glasgow Coma Score to rehabilitative potential in patients suffering traumatic brain injury. Am J Surg 2003; 69: 491-497
    PubMedGoogle Scholar
  • Vilkki J, Ahola K, Holst P et al. Prediction of psychosocial recovery after head injury with cognitive tests and neurobehavioral ratings. J Clin Exp Neuropsychol 1994; 16: 325-338
    CrossrefPubMedGoogle Scholar
  • Wallesch CW, Curio N, Galazky I et al. The neuropsychology of blunt head injury in the early postacute stage: effects of focal lesions and diffuse axonal injury. J Neurotrauma 2001; a 18: 11-20
    CrossrefPubMedGoogle Scholar
  • Wallesch CW, Curio N, Kutz S et al. Outcome after mild-to-moderate blunt head injury: effects of focal lesions and diffuse axonal injury. Brain Inj 2001; b 15: 401-412
    CrossrefPubMedGoogle Scholar
  • Widder B. Vaskulär bedingte Hirnprozesse. Rauschelbach HH, Jochheim KA, Widder B, (Hrsg.) Das neurologische Gutachten. Stuttgart: Thieme; 2000
    Google Scholar
  • Widder B. Grundsätze der Begutachtung. In: Wallesch CW, Unterberg A, Dietz V, (Hrsg.) Neurotraumatologie. Stuttgart: Thieme; 2005
    Google Scholar
  • Widder B, Gaidzik PW (Hrsg.) Begutachtung in der Neurologie. 2. Aufl. Stuttgart: Thieme; 2011
    Google Scholar
  • Wurzer W. Das posttraumatische organische Psychosyndrom. Wien: WUV Universitätsverlag; 1992
    Google Scholar