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Subduralblutungen

Ursachen, Arten, Folgen und forensische Aspekte

Subdural hematomas. Causes, types, consequences and forensic aspects

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Zusammenfassung

Der vorliegende Beitrag bietet eine orientierende Übersicht über Häufigkeiten, Einteilungsmöglichkeiten, Ursachen, Blutungsquellen, Symptomatik, zeitliche Entwicklung und Prognose von Subduralblutungen bzw. Subduralhämatomen – aus primär nicht klinischer, sondern postmortaler bzw. forensischer Sicht. Aufgrund deutlicher Unterschiede dieser Blutungen abhängig von der Art der intrakraniellen Verletzung erscheint eine Unterteilung in „Hirnverletzung mit Subduralhämatom“ und „isoliertes Subduralhämatom“ angemessen. Beim 2. Typ sollte dann auch nach den beiden Hauptursachen „Brückenvenenverletzung“ und „Rindenarterienläsion“ unterschieden werden. Die Situation bei arteriell bedingten isolierten Subduralhämatomen ist durch einige klinische Angaben von nicht traumatisch verursachten, sondern spontan eingetretenen Fällen kompliziert. Auf diesen Aspekt wird in der forensischen Literatur bisher nur sehr wenig eingegangen. Neben subduralen Blutungen kann es bei Kopftraumen auch zu traumatisch bedingten Hygromen kommen, aus denen sich mitunter sekundär auch Blutungen entwickeln und die u. U. auch das Auftreten einer neuerlichen Verletzung bei anscheinend geringem Trauma erleichtern können.

Abstract

This review surveys subdural hematomas, including general knowledge presented in the literature as well as own experiences. Main topics are: frequency, causes, types, clinical symptoms, development, risk factors, prognosis of subdural hematomas and injured structures predominantly responsible for such bleedings. Focal points of the presentation are forensic aspects, not clinically important details. Generally, a reduction of the diagnosis as “subdural hematoma” seems to be problematic. Firstly a subdivision in “hematomas in patients with relevant injuries of the cerebral tissue” (like contrecoup-lesion) and “... without cerebral injury” (pure, respectively isolated) is necessary, because the predominant causes of such cases differ, and (forensic) experiences with one of these classes cannot be completely transferred to the other. Secondly, in pure subdural hematomas the source of bleeding, i.e. the type of injured vessel should be characterized – if ever possible. Ruptures of cerebral bridging veins are generally looked at as traumatically caused. In contrast, following clinical literature hemorrhages from cortical arteries sometimes occur spontaneously. This aspect seems to be not sufficiently discussed in forensic literature. An excursion to traumatic subdural hygromas rounds off this presentation.

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  1. Institut für Rechtsmedizin, Charité - Universitätsmedizin Berlin, Turmstraße 21, 10559, Berlin, Deutschland

    H. Maxeiner

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In Erinnerung an ein fachliches wie persönliches „Urgestein“, dem näher zu begegnen einen wesentlichen Grundstein dazu legte, dass ich dem Fach nahe kam: W. Krauland.

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Maxeiner, H. Subduralblutungen. Rechtsmedizin 19, 111–128 (2009). https://doi.org/10.1007/s00194-008-0585-9

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