engleski

Role of Diagnostic Imaging Methods in Confirmation of Brain Death in Clinical Pratice

INTRODUCTION: The diagnosis of brain death (BD) was first defined by Ad Hoc Comitee of the Harvard Medical School. Most countries define brain death as irreversible loss of brain function, including the brain stem. With regards to confirmatory tests legislation ranges from not necessary to obligatory. In Croatia confirmatory tests are obligatory and currently 7 ancillary tests (TCD, DSA, MSCTA, MRA, EEG, Tc-HMPAO, Evoked potentials) are equally accredited . In our hospital TCD, DSA , MSCTA and evoked potentials were used to demonstrate the cessation of cerebral circulation. TCD was preferred due to bedside evaluation. METHODS: A retrospective research was conducted with insight into medical history of patients who in 2012 were treated for severe brain lesions , which finally led to BD . After the clinical diagnosis of brain death was made, the appropriate confirmatory test was chosen. RESULTS: In 31 out of 36 patients clinical diagnosis of BD was confirmed with ancillary test. TCD was positive in 13 patients, MSCTA in 9 , evoked potentials in 6 and DSA in 3 patients. MSCTA was repeated twice in 3 patients and three times in 1 patient. In 3 out of 11 patients, who underwent MSCTA, BD could not be confirmed because of residual brain flow. 2 patients died during the observational period. CONCLUSION: Although most countries agree upon the definition of BD, there is a discrepancy betwen the means by which it is determined. We find that using confirmatory tests helps in diagnosis and also shortens the time in which it is established. This is very important with regards to transplantation programe. We would like to encourage the discussion that would help define more uniform guidelines and standardise the usage and interpretation of ancillary tests.

MSCT; Angiography; Brain Death

nije evidentirano