Diferencijalna dijagnoza poremećaja svijesti

master's thesis

• Title (english): Differential diagnosis of consciousness disorders
• Author: Monika Mudrovčić
• Mentor: Željka Petelin Gadže (mentor)
• Committee member: Zdravka Poljaković (predsjednik povjerenstva)
• Committee member: Mario Habek (član povjerenstva)
• Committee member: Željka Petelin Gadže (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Medical Statistics, Epidemiology and Medical Informatics); Zagreb
• Defense date and country: 2016-09-28, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Brojna stanja u medicini, od hipoglikemije do traumatskih intrakranijalnih krvarenja, kao vodeći simptom imaju promijenjenu svijest. Ta razdoblja promijenjene svijesti mogu trajati od nekoliko sekunda (primjerice, u sinkopi) do nekoliko dana i tjedana, pa sve do toga da pojedini pacijenti čitav život provedu s protrahiranim poremećajima svijesti kao što su minimalno svjesno stanje (minimally conscious state, MCS) ili perzistentno vegetativno stanje (PVS). Kako su napreci u medicinskoj znanosti i tehnologiji omogućili dulje preživljenje pacijenata u stanjima poremećene svijesti, svakim danom raste na važnosti problem njihovog međusobnost razlikovanja i ranog prepoznavanja njihovih uzroka.
Osnova za uspostavljanje ispravne dijagnoze poremećaja svijesti je, možda više nego li igdje drugdje u kliničkoj neurologiji, dobro poznavanje neuroanatomije i dobra vještina primjene tog znanja na ispitivanje neurološkog statusa. Ascendentni retikularni aktivacijski sustav (ARAS) moždanog debla, koji sadrži glavne strukture za regulaciju budnosti i spavanja, smješten je blizu jezgara čija se funkcija može klinički ispitati čak i u pacijenata bez svijesti, što omogućuje lokalizaciju potencijalne strukturalne lezije i procjenu štete. Radiološke, laboratorijske i elektrofiziološke pretrage služe daljnjem prepoznavanju različitih uzroka poremećaja svijesti. Ovaj rad ima za cilj dati kratak pregled tih uzroka, patofiziologije oštećenja koja stvaraju i specifičnosti u njihovoj manifestaciji na osnovi kojih se mogu razlikovati. Utvrđivanje potpunog prestanka moždane aktivnosti, poznatog kao moždana smrt, je također svakim danom sve relevantnije pitanje, a od posebne je važnosti u transplantacijskoj medicini.

Abstract (english)

A wide spectrum of disorders, ranging from intracranial hemorrhage to hypoglycemia, present with impaired consciousness as a leading symptom. The duration of these periods of impaired consciousness varies from less than a minute (for example, in syncope) to days and weeks at a time, with certain patients confined to a lifetime of disordered consciousness in states such as minimally conscious state (MCS) and persistent vegetative state (PVS). As improvements in medical science and technology increase the survival of patients in states of impaired consciousness, the problem of properly differentiating between these states and recognizing their causes early on steadily grows in importance.
The basis for establishing a correct diagnosis of these disorders is, perhaps even more so than in other areas of clinical neurology, a strong grasp of neuroanatomy and its skillful application in the neurological examination. The ascending reticular activating system (ARAS) of the brainstem, the main pathway regulating wakefulness and sleep, lies in close proximity to certain nuclei whose function can be clinically tested even in unconscious patients, allowing for localization of a potential focal lesion and assessment of damage. Neuroimaging, laboratory testing and electrophysiological studies can further identify different levels and causes of consciousness disorders. This paper aims to review these potential causes, the pathophysiology of the damage they cause and the specificities in their manifestation that can be used to differentiate between them. Determining the complete absence of brain activity, also known as “brain death”, is an increasingly important issue, especially relevant in transplantation medicine.

• Keywords: svijest; koma; ascendentni retikularni aktivacijski sustav; moždana smrt
• Keywords (english): consciousness; coma; ascending reticular activating system; brain death
• Language: croatian
• URN:NBN: urn:nbn:hr:105:208175
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-08-10 06:36:01