DE10100794A1 - Brain damage equipment comprises fitted helmet with in built cooler and function-monitoring instruments and elasticated size-adaptable crown area - Google Patents

Abstract

A helmet (5) is placed over the patients head complete with cooling device (7) and closed round the neck by tabs (4) with buckle (8). The helmet has an elastic zone in the crown and the outside of the helmet is low on heat conductance as against the inside which conducts heat well. Cooling (7) is by cold running water or again by coolers and uses cooling chambers for medium as appropriate. Instruments (5) in the helmet monitor body functions.

Description

The nerve cells as descendants of the so-called outer embryonic cotyledon (cerebrum, Cerebellum, retina, spinal cord etc.) is so high in contrast to other body cells Energy needs in common that they are oxygen only under everyday conditions can do without a few minutes. However, since it can only be supplied via the bloodstream is, it occurs with every circumscribed narrowing or even relocation of the bloodstream in the affected brain area rapidly lead to massive metabolic disorders in the nerve cells very quickly lead to their functional failure and ultimately their death.

Accordingly, there is a cardiac arrest (coronary infarction, etc.), even if it only Lasts minutes (Adam-Stoke's attack) due to complete failure of the whole Blood circulation also threatens the entire brain substance from rapid death. This as To call "brain death" is linguistically wrong, since organs and individual cells are not die, can only die, it is a death of man but not of the brain can give. But a dead brain or heart can very well cause the human death. Heart or brain death has therefore always been understood to mean: H. before transplant medicine took possession of these terms, only one Reference to the circumstances that lead to our death, similar to how we did from Speak "suffocation" or "starvation" and do not mean that suffocation and Died of hunger.

In the vernacular, it is therefore more correctly called the complete or extensive Functional heart failure a "heartbeat" (heart attack), the sudden, on Circulatory disorder-related failure in the brain called a "stroke" or "stroke" (Apoplexy, apoplectic insult).

This conceptual clarity of our colloquial language is therefore of great importance in this case Significance because, on the one hand, the vast majority of those in Germany annually with around 500,000 figured apoplexies, but also the numerous heart attacks in the home environment (i.e. preclinical), on the other hand, because the prospect of recovery of the affected Brain cells from minute to minute, but especially from hour to hour so quickly disappears that early detection, especially by the layperson or transport assistant, is crucial is.

On the medical side, we are able today through special imaging procedures Distinguish between (computed tomography, NMR, positron emission tomography, ultrasound, etc.), whether the apoplexy is a less frequent - bleeding from the brain (e.g. in Aneurysm or vascular rupture) or the much more common circumscribed narrowing of larger or smaller arteries in the brain, for example due to atheromatous deposits in the Carotid arteries, blood clots (immediately on site or embolic), such as in the cerebral artery, or primarily for more extensive ones reflex constrictions (spasms) that are peripheral to the Capillaries can adjust so that it is also used in these areas to reduce the Circulation comes (ischemia).  

However, such diagnostics are only reserved for special clinics and are also very time-consuming, so that this is inevitably at the expense of treatment, which alone can help, since the So-called "therapeutic windows", d. H. the period from the occurrence of the fault to irreversible damage in general and on average only gets about 3 hours is specified, but can also be significantly shorter or longer due to accompanying circumstances, depending after whether there are spontaneous remissions, d. H. comes to re-perfusion or to what extent In terms of the system, the patient is destroyed by abundant arterial collaterals (escape vessels) and the peripheral vessels react with compensatory expansion. The larger one also comes loose Part of the emboli spontaneously, but unfortunately not always in time, and finally can, as described several times in the literature, intact neighboring areas - even in the corresponding region of the other hemisphere - functions of its metabolism (Metabolism) take over disturbed cells alternatively, so that these, if not yet dead, at least a certain "shadow existence" (Perumbra) although the lack of oxygen leads to a malfunction of their so-called ion pumps and thus before everything has led to the fatal flooding of the cell interior with Ca ions.

All of these findings make it clear that this essentially remains decisive for medical healing success:
The earliest possible start of targeted maximum medical treatment, i.e. shortening the preclinical time in favor of clinical diagnostics and therapy, which in addition to trying to reduce the stenosis (lysis, re-perfusion) also by influencing the circulation (blood pressure, blood volume, anticoagulation) and breathing ( Orthocapnia in the first place makes it possible to bring oxygen, but also medication, into the crisis area, in particular neuroprotective substances, calcium antagonists and glutamate inhibitors, which can contain the faulty cell metabolism and thus high oxygen demand.

Unfortunately, none of these therapeutic measures is suitable, in lay hands to be placed, especially since the diagnostics necessary for this at least at home or would require emergency medical experience, and this is where the well-intentioned "low headroom" or "Spend on your side" not simply the egg of Columbus, sometimes even may be contraindicated.

Therefore, the most effective, but also without time-consuming fine diagnostics, can be initiated immediately Treatment, namely the Reduction of oxygen demand in the damaged area must be simplified so that they immediately after the apoplectic insult, resp. Cardiac arrest, i.e. preclinical, even by a trained layperson can be initiated.

The hypothermia practiced in the specialist clinic to remedy the oxygen deficit affected brain region via a distraction of the entire body temperature par excellence is only possible and is invasive and with an intact or artificially maintained blood circulation therefore unsuitable for domestic use.

Therefore, an attempt must be made to cool down the injured directly Brain area, which does not rely on an intact blood circulation, already on site enable. Since serious epoplexies occur in both the gray matter of the Cerebral cortex as well as the underlying brain marrow, it is still sufficient in  essential, over the bony skull roof with the bark immediately below to achieve hypothermia, since only this essentially from the actual, high metabolically active, but therefore extremely sensitive cell bodies of the brain substance (gray Substance) while the marrow (white substance) consists essentially of axons and Dendrites, i.e. H. the much less sensitive nerve extensions of these brain cells that are similar to the large nerve strands to and in our limbs that as is well known, the relatively small, but tailor-made one that is necessary for you Form of energy (similar to the light bulb its current) finished from the actual, in brain and Spinal cord lying, very susceptible to disruption (similar to a power plant) get complex metabolisms. Survives an electrical plant due to sufficient coal and intact ovens etc., the cable also no longer owes electricity unless it is cut through by an accident.

The cerebral cortex is only less than 1 cm thick, due to its strong corrugation - better known as crinkling - but it takes a zone directly under the skull of about 3-4 cm depth, which must be included in the calculation of the necessary cold dose.

With oxygen loss in the entire brain (cardiac arrest) or with apoplexies in the deeper brainstem, which are usually particularly serious, the cold, to get to the scene quickly, with a bit lower overall Temperatures affect the skull bones, but this is due to the stricter vital Indication quite reasonable.

Already a few degrees Celsius lower the oxygen requirement of the brain substance significantly and counteract the disturbing edema formation (local swelling). At 32 degrees, one should probably not go preclinical, at 30 degrees side effects cannot be ruled out, not least because the supercooled blood from the brain reaches the heart via the cerebral veins and the sinuses just below the skull bone and triggers a standstill there can. But if there is already one, the cold vein blood cannot flow back to the heart at all. If the cardiac arrest is already present, the lower risk of hypothermia and thus possibly promoting the standstill stands in contrast to the all the more clear vital indication for rapid and pronounced hypothermia in the entire brain.

So even if the percranial hypothermia of the brain is about an invasive intensity The former cannot be equal to the bloodstream because of its many procedures earlier applicability in most cases of purely clinical treatment Far superior in terms of prognosis, especially since the latter in no way delayed or diminished or even prevented

The invention has for its object to provide a device that is fast Treatment of the brain in the incidents described enables.

This object is achieved according to the invention by the features of patent claim 1.

Only a few regulations would apply to the laypersons who deal with it to note, and only certain but few eye-catching signs of apoplexy (Paralysis, ptosis, wide pupil, etc.) must be observed and therefore communicated to the layperson.  

Theoretically, even if the sick side was recognized, the Cold radiation primarily on the affected, d. H. a half of the brain can be directed. Here one would have to note, however, that the so-called pyramidal paths in the brain stem are the largest Cross part and consequently some peripheral paralysis that occur on one side have their cause in the other side of the brain, but with which the helpers in general are overwhelmed.

The cardiac arrest that is so threatening in the case of a first infarction, but especially in the case of recurrence, is from the layperson because of the apparently premortal appearances it is hard to miss (suddenly violent retrosternal pain, missing or very flying superficial pulse, severe Cardiac arrhythmia, waning breathlessness) and for those percranial hypothermia, as long as medical help is not yet available, the highest vital indication. What good is it if the patient's heart, circulation and breathing in the clinic be restored, but an apallic syndrome, d. H. forever a far-reaching one Loss of consciousness remains.

For patients at risk of recurrence, the helmet can also be placed in a small ice box store so that the cold is even faster in the event of a relapse to be expected in this way is available.

Further training results from the subclaims.

The helmet shown in Figs. 1 and 2 as an example in two views in section is similar to the helmet of a motorcycle rider (integral helmet), which ends in a straight line at the front over the eyebrows, from the outer end directly behind the ear attachment down to Mastoid (mastoid process) on both sides and then from there across the neck somewhat below the Protuberantia occipitalis externa (occipital bump).

Below the bimastoid line, the occipital boundary of the Helmet main part has a flexible bend on both sides and a sponge-like flap on the inside on both sides pulling forward over the carotid area and with the rag the opposite side in the area of the Adam's apple through a band-shaped buckle that is adjustable connected is. This ensures that the helmet is always under the jaw angle cushion-like and close to the neck (good adaptation to the carotid), so here Measure instruments blood drought, pulse and blood temperature and, if necessary, if it is too high Can switch off blood cold.

To ensure that the helmet fits as many head shapes and sizes as possible is, it must have a 1-2 cm wide highly elastic in the crown, from the forehead to the occiput running band-shaped zone that can act as a hinge when you put the helmet on open up at the bottom because of the special head thickness, d. H. must diverge. This band-like zone should not have a cold-generating insert, since it is immediate beneath her the venous sinus already mentioned runs, by the venous blood towards the heart flows and should therefore not be too cold.

Also the two helmet flaps pulling towards Adam's apple, which practically the upper part of the neck, due to their flexibility and elasticity and the mentioned adjustable buckle for optimal helmet adaptation. The average width the same could hardly be much less in women because of the more pronounced hair fail than the man. Because apoplexy is very rare in children - which is  also applies to cardiac arrest - here the provision of a special helmet is probably only in Exceptional cases displayed.

The outside of the helmet must of course be very small, the inside of very good Be heat conduction. The total thickness of the home shell should be about 1-3 cm and possibly have a low elasticity to ensure that the helmet fits well guarantee.

The cooling device is housed in the home shell. The temperature drop can using a flow system (cold water) or many individual cooling units, can be achieved by dry ice or a wide variety of chemical processes, whereby perhaps in any case because of the simplicity of the pure rinsing with cold water a hose should be possible at least optionally, especially since a cold water jet as well how the electric current is probably available in every apartment today. For transportation the independence of an electric accumulator of value, but also leaves cold water in a portable cool box for this purpose in the house or any medical car ready.

With all these considerations, it should be borne in mind that the helmet is generally at its best needs to cool for a few hours, and not, like an icebox, for many days, which is safe simplification. It is also not that crucial that being therapeutic to achieve the highest possible, but the soonest possible reduction, since the Oxygen requirements of the brain cells not only decrease linearly with the degrees of Celsius, but also decrease more steeply. It is always astonishing that sometimes drowned people on the bottom of a body of water Survive for several hours without breathing and heartbeat and therefore without oxygen can, the brain cells at z. B. 10 degrees or lower their metabolism almost are able to stop completely without dying off. With the preclinical Hypothermia, however it may be, is something gained in any case, although one must remain aware that the more hypothermia it was, even more so when reheating to unpleasant circumscribed veins Damage to the capillaries and a. can come and with it the resuscitation carries greater dangers.

Good permeability to the scalp, the bones of the skull and the skin Brain substance can be assumed.

The extension flaps of the helmet pulling over the carotid not only serve the good ones Adjustment of the helmet, but, as already mentioned, contain measuring instruments for pulse, Blood pressure and arterial blood temperature etc. Thermometers are still in the bowl of the helmet. The necessary consequences from the determined values must be followed Computer technology is calculated and automatically implemented via a controller.

The drawing shows the cerebral cortex 1 , the cerebral medulla 2 , the scalp 3 and the vein sinus 4 of a person. The slightly flexible helmet 5 has a cooling device of the type described and is provided with flexible helmet flaps 6 for enclosing the neck and a buckle 8 .

Claims (8)

1. Medical device for treating the brain with a helmet ( 5 ) that can be placed on the patient's head and has a cooling device ( 7 ). 2. Device according to claim 1, wherein the helmet ( 5 ) is provided with the neck-enclosing tabs ( 6 ) on which a buckle ( 8 ) is attached. 3. Device according to claim 1 or 2, wherein the helmet has a band-shaped elastic zone ( 9 ) in the apex. 4. Device according to one of claims 1-3, wherein the outer side of the helmet is low and the Helmet inside has good thermal conductivity. 5. Device according to one of claims 1-4, wherein the cooling device ( 7 ) is formed by a cold water flow system. 6. Device according to one of claims 1-4, wherein the cooling device ( 7 ) has cooling units in the helmet ( 5 ). 7. Device according to one of claims 1-4, wherein the cooling device ( 7 ) has cooling chambers for a cooling medium. 8. Device according to one of claims 1-7, in which in the helmet ( 5 ) measuring instruments for body functions are installed.