Title Diferencijalna dijagnoza smrti mozga Title (english) Differential diagnosis of brain death Author Anamarija Kruc Mentor Ante Sekulić (mentor)Committee member Mladen Perić (predsjednik povjerenstva)Committee member DINKO TONKOVIĆ (član povjerenstva)Committee member Ante Sekulić (član povjerenstva)Granter University of Zagreb Defense date and country 2017-07-14, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Ovaj rad donosi pregled literature o diferencijalnoj dijagnozi smrti mozga. Smrt mozga definirana je kao ireverzibilni prestanak svih funkcija mozga i moždanog debla. Tri osnovna nalaza u smrti mozga su koma, odsutnost refleksa moždanog debla i apneja. Utvrđivanju smrti mozga pristupa se kod pacijenata koji su pretrpjeli masivnu, ireverzibilnu ozljedu mozga utvrđenog uzroka. Pacijent koji je proglašen moždano mrtav, legalno je i klinički mrtav. Potrebno je naglasiti važnost pravodobne i točne dijagnoze smrti mozga, isključujući stanja koja oponašaju smrt mozga. U pregledu su prikazana stanja koja mogu zavarati i tako dovesti do nesigurnosti i kašnjenja u donošenju ispravne dijagnoze smrti mozga. Locked-in sindrom, posljedica katastrofalne ozljede gornjeg dijela ponsa, u kojoj je pacijent potpuno svjestan svega, ali se ne može kretati ili verbalno komunicirati s okolinom, osim vertikalnih pomaka očiju. Fulminantni GBS, stanje je koje u samo nekoliko dana može progredirati u stanje nalik smrti mozga gdje, ako se ne utvrdi reverzibilnost, može ostaviti trajne posljedice na pacijenta. Duboka hipotermija, najimpresivnije je stanje koje oponaša smrt mozga, sa temperaturama ispod 28°C, gdje se gube svi refleksi moždanog debla. Trovanje barbituratima i ostalim CNS depresorima česti su uzrok zabuna u dijagnosticiranju smrti mozga te se danas obavezno rade toksikološke analize kod pristupa dijagnosticiranja komatoznih pacijenata. Akinetički mutizam, stanje duboke apatije, sa očuvanom svijesti, ali slabih i sporih dobrovoljnih pokreta, razlikuje se od smrti mozga te se parakliničkim testom uz pomoć EEG-a jasno može dokazati da takav pacijent nije moždano mrtav. Važnost isključivanja stanja koja oponašaju smrt mozga leži u mogućnosti doniranja organa moždano mrtvih osoba (DBD protokol). Iako medicina i tehnologija napreduju i ostvaruju maestralna otkrića, potražnja za organima i dalje premašuje ponudu.
Abstract (english) The goal of this paper is to provide a systematic overview of literature regarding the differential diagnosis of brain death. Brain death is defined as the irreversible loss of all functions of the brain, including the brainstem. The three essential findings in brain death are coma, absence of brainstem reflexes, and apnea. An evaluation for brain death should be considered in patients who have suffered a massive, irreversible brain injury of identifiable cause. A patient determined as brain dead is legally and clinically dead. It is necessary to emphasize the importance of timely and accurate diagnosis of brain death, by excluding conditions that mimic brain death. In this review are presented conditions that can mislead and thus lead to uncertainty and delays in making a proper diagnosis of brain death. Locked-in syndrome is a catastrophic result of an infarction of the upper part of the pons cerebri, in which the patient is fully aware of everything, but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body, except for vertical eye movements. Fulminant GBS, a condition that can rapidly progress to a brain death - like state in just a few days where, if no reversibility is established, it can leave permanent consequences for the patient. Deep hypothermia is the most impressive condition that mimics brain death, with temperatures below 28 ° C, where all the reflexes of the brain stem are lost. Barbiturates overdose and other CNS depressants intoxications are a common cause of confusion in the diagnosis of brain death. Therefore, today, toxicological screenings are mandatory when diagnosing comatose patients. Akinetic mutism, a state of deep apathy, with conserved consciousness, but weak and slow voluntary movements, is different from brain death and an instrumental test such as EEG can clearly prove that such a patient is not brain dead. The importance of excluding conditions that mimic brain death lies in the possibility of organ donation from brain dead patients (DBD protocol). Although medicine is progressing and making maestral discoveries, the demand for organs continues to exceed the bid.
Keywords
smrt mozga
diferencijalna dijagnoza
doniranje organa
Keywords (english)
brain death
differential diagnosis
organ donation
Language croatian URN:NBN urn:nbn:hr:105:181883 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2018-01-11 11:51:58
