Za smrť mozgu je považovaný stav, kedy vymiznú všetky funkcie mozgu a mozgového kmeňa, bez ohľadu na pretrvávajúce kardiovaskulárne, či iné orgánové funkcie. Celosvetovo nie je postup diagnostiky mozgovej smrti jednotný. Slovenská republika uzákonila postup pri stanovení mozgovej smrti, ktorý s menšími úpravami platí od 70-tych rokov minulého storočia dodnes. U detských pacientov dochádza k smrti mozgu z rôznych príčin, kritériá pre jej stanovenie musia spĺňať viacero predpokladov a klinické určenie sa vykonáva v závislosti od veku dieťaťa. Spísanie zápisnice o smrti mozgu spolu s kladným, hoci právne nepovinným súhlasom zákonných zástupcov s darovaním orgánov zverenej osoby nám otvára možnosti transplantácie orgánov aj v detskom veku.

Brain death is considered a condition where all functions of the brain and brain stem disappear, regardless of persistent cardiovascular orother organ functions. Globally, the procedure for diagnosing brain death is notuniform. The Slovak Republic enacted a procedure for determing brain death, which with minor modifications has been in effectsince 1970 s until these days. In pediatric patients, brain death occurs for various reasons, the criteria for its determination must meet several prerequisites, and the clinical determination is made depending on the age of the child. The documentation of brain death together with non mandatory positive consent of legal representative swith the donation of the entrusted person’s organs open sup the possibility of organ transplantation even in child hood.

• Keywords
• stanovení smrti mozku,
• MeSH
• Tissue Donors MeSH
• Child MeSH
• Brain Death MeSH
• Cadaver MeSH
• Check Tag
• Child MeSH

Kritériá mozgovej smrti sú medicínsky a legislatívne akceptované vo svete už viac ako polstoročie. Cieľom predkladaného článku je definovať legislatívny rámec diagnostiky smrti mozgu a postup diagnostiky v Slovenskej a Českej republike. V diskusii na základe súčasných vedeckých poznatkov bližšie rozoberáme predpoklady a kontraindikácie diagnostiky smrti mozgu.

The criteria for brain death have been medically and legally accepted worldwide for more than half a century. The aim of the presented article is to describe the legal framework for brain death diagnostics and the diagnostic procedure in the Slovak and Czech Republics. In the discussion, based on current scientific knowledge, we further analyze the preconditions and contraindications for brain death diagnostics.

• MeSH
• Contraindications MeSH
• Humans MeSH
• Brain Death * diagnosis   legislation & jurisprudence   MeSH
• Neurologic Examination MeSH
• Legislation as Topic MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH
• Geographicals
• Czech Republic MeSH
• Slovakia MeSH

Smrt mozku definujeme jako stav po katastrofálním poškození mozku s trvalou nevratnou ztrátou všech funkcí celého mozku, včetně kmene. Stanovení diagnózy je založeno na klinickém vyšetření, kdy je zcela nepřípustná falešná negativita jednotlivých testů, které podporují ireverzibilní postižení mozkového kmene od mesencefala (fotoreakce) přes pons Varoli (korneální, okulocefalický reflex a algické podráždění v obličeji) až po prodlouženou míchu (dávivý a kašlací reflex). V současné době není jasně stanovena metodika provedení jednotlivých vyšetření. Tento článek pojednává o základním klinickém vyšetření při stanovení smrti mozku a apnoickém testu. Součástí publikace je rovněž soubor videí, která ukazují pozitivní nález při stanovení smrti mozku (čili areflexii) a nález, který není kompatibilní se smrtí mozku (přítomnost normální odpovědi).

We define brain death as a condition following catastrophic brain injury with permanent irreversible loss of all functions of the entire brain, including the brain stem. Diagnosis is based on clinical examination, where are completely unacceptable false negative individual tests that support irreversible brainstem involvement from the mesencephalon (photoreaction) to the pons Varoli (corneal, oculocephalic reflex and facial alginic irritation) to the medulla oblongata (gag and cough reflex). At present, the methodology for performing each exa­mination is not clearly established. This article discusses the basic clinical examination in the determination of brain death and the apnea test. The publication also includes a set of videos that show a positive finding in the determination of brain death (absence of reflex) and a finding that is not compatible with brain death (presence of a normal response).

• Keywords
• apnoický test, funkce mozkového kmene, reflexy mozkového kmene,
• MeSH
• Diagnostic Techniques, Neurological MeSH
• Humans MeSH
• Brain Death * diagnosis   MeSH
• Brain Stem MeSH
• Neurologic Examination MeSH
• Reflex MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Povinnost i podmínky potvrzujících vyšetření smrti mozku jsou dány legislativou příslušné země. Potvrzující vyšetření nepřipouští eventualitu falešné pozitivity (potvrzení smrti u žijícího jedince). Je žádoucí, aby metodika vyšetření i hodnocení byla jasná, přesná a jednotná. Metodika sluchových evokovaných odpovědí (BAEP) vychází z oficiálních mezinárodních doporučení a je přizpůsobena pro podmínky jednotek intenzivní péče. Vyšetření BAEP před rozvojem kraniokaudální deteriorace nebo rozšíření o somatosenzorické evokované odpovědi n. medianus zvyšují spolehlivost (senzitivitu) potvrzujícího vyšetření provedeného po splnění všech klinických podmínek diagnózy smrti mozku dle neurologických kritérií "brain death / death by neurological criteria".

The obligation and conditions of confirmatory brain death examinations are determined by the legislation of the respective country. Ancillary examinations do not allow for the possibility of a false positive (confirmation of death in a living individual). It is desirable that the methodology of examination and evaluation is clear, precise and uniform. The methodology of auditory evoked responses (BAEP) is based on official international recommendations and is adapted to intensive care unit (ICU) conditions. BAEP examination before the development of craniocaudal deterioration or augmentation with median nerve somatosensory evoked responses (SEP) increases the reliability (sensitivity) of ancillary testing performed after all clinical conditions for a diagnosis of brain death according to neurological criteria (BD/DNC) have been met.

• Keywords
• potvrzující vyšetření,
• MeSH
• Electrodiagnosis methods   MeSH
• Evoked Potentials MeSH
• Humans MeSH
• Brain Death * diagnosis   MeSH
• Evoked Potentials, Auditory, Brain Stem MeSH
• Evoked Potentials, Somatosensory MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Smrť mozgu zostáva klinickou diagnózou, vo väčšine prípadov založenou na klinickej diagnostike. Doplnkové testy vrátane zobrazovacích vyšetrení sa používajú na potvrdenie absencie cerebrálnej perfúzie, keď sú klinické nálezy nejednoznačné. Zobrazovacie metódy ako DSA, perfúzna scintigrafia a transkraniálny Doppler môžu poskytnúť kľúčové, zákonom vyžadované údaje na podporu diagnózy. Napriek prebiehajúcim snahám neexistuje celosvetový konsenzus o optimálnom doplnkovom teste a prax sa líši podľa regiónov. Moderné vyšetrenia ako CT angiografia (CTA), MR techniky, CT perfúzia a časovo invariantná CTA ponúkajú stále presnejšie výstupy. Je však potrebná ich ďalšia validácia, zvlášť v prípade pediatrických pacientov. Včasná diagnóza smrti mozgu minimalizuje zbytočné výkony a umožňuje následný efektívny transplantačný program.

Brain death remains a clinical diagnosis, based mainly on clinical criteria. Ancillary tests, including diagnostic imaging, are used to confirm the absence of cerebral perfusion when clinical findings are inconclusive. Imaging methods like DSA, perfusion scintigraphy and transcranial Doppler can provide critical, legally required data to support the diagnosis. Despite ongoing efforts, there is no global consensus on the optimal ancillary test, with practices varying by the region. Modern techniques like CT angiography (CTA), MR imaging, CT perfusion and time-invariant CTA, offer increasingly accurate outcomes. However, further validation is needed, particularly for pediatric patients. Early brain death diagnosis is crucial to avoid unnecessary interventions and to support timely organ transplantation.

• MeSH
• Diagnostic Imaging methods   MeSH
• Humans MeSH
• Brain Death * diagnostic imaging   MeSH
• Neuroimaging methods   MeSH
• Radionuclide Imaging methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Stanovenie smrti človeka je všeobecne bezproblémové a nevyžaduje špeciálne vzde­lanie ani zručnosti. V malej časti prípadov ale nie je vôbec jednoduché určiť, či je osoba mŕtva alebo živá. Situáciu komplikuje aj potreba definovať čas a príčinu smrti. Autori v článku rozoberajú históriu definovania a stanovenia smrti človeka od 18. storočia (obdobie akcelerácie anatomicko-fyziologického poznania) až dodnes. Osobitný zreteľ je venovaný konceptu používanému v poslednom polstoročí, a to smrti mozgu založenej na neurologických kritériách. Zároveň zdôrazňujú, že problematika smrti je kombináciou odborne medicínskych, morálne etických, filozoficko-náboženských a legislatívne právnych aspektov spolu s emocionálnym pozadím ľudí blízkych zomretým osobám.

Determining a person's death is generally unproblematic and requires no special education or skill. In a small proportion of cases, however, it is not at all easy to determine whether a person is dead or alive. The situation is further complicated by the need to define the time and cause of death. In the article, the authors discuss the history of defining and determining the death of a person from the 18th century (a period of accelerated anatomical-physiological knowledge) until the present day. Particular attention is paid to a concept used in the last half-century, namely brain death based on neurological criteria. Also, emphasis is placed on the fact that the issue of death is a combination of professional-medical, moral-ethical, philosophical-religious, and legislative-legal aspects along with the emotional background of those who are close to the deceased ones.

• MeSH
• Diagnostic Techniques, Neurological MeSH
• Ethics, Medical MeSH
• Humans MeSH
• Brain Death diagnosis   legislation & jurisprudence   MeSH
• Death * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Historical Article MeSH

Hyponatremie je stanovena jako koncentrace sodíku nižší než 135 mmol/l. Jedná se o celosvětově nejčastější poruchu elektrolytů. Nejčastějšími projevy hyponatremie jsou gastrointestinální a neurologické obtíže. Příležitostně může vést hyponatremie k poruchám srdečního rytmu. V námi prezentované kazuistice vedla těžká hyponatremie k sinusové bradykardii s alternujícím stupněm atrioventrikulární blokády a srdeční zástavě. Obnovení sinusového rytmu bylo dosaženo až po úpravě koncentrace sodíku. Těžká hyponatremie a protrahovaná zástava oběhu však u pacienta vedly k malignímu otoku mozku. Tento jedinečný případ zdůrazňuje kritickou roli sodíku v srdeční elektrofyziologii a ukazuje důležitost monitorace koncentrace sodíku u pacientů se zástavou oběhu.

Hyponatremia, characterized by sodium levels below 135 mmol/l, is the most prevalent electrolyte disorder worldwide. It presents with a wide range of clinical symptoms, particularly in the neurological and gastrointestinal domains, occasionally leading to cardiac arrhythmias. In our specific case, severe hyponatremia resulting from potomania resulted in sinus bradycardia with alternating atrioventricular block and subsequent cardiac arrest. Restoration of sinus rhythm was achieved following correction of the sodium levels. However severe hyponatremia and long-lasting CPR resulted in brain oedema, which ultimately led to brain death. Per national regulations, the patient was enrolled in an organ donor program, resulting in successful organ transplants. This unique case underscores the critical role of sodium levels in cardiac electrophysiology and highlights the necessity of monitoring electrolyte levels in patients experiencing cardiac arrest.

• MeSH
• Brain Edema etiology   MeSH
• Electrocardiography MeSH
• Phosphopyruvate Hydratase analysis   MeSH
• Hypertrophy, Right Ventricular complications   MeSH
• Hyponatremia * complications   MeSH
• Cardiopulmonary Resuscitation MeSH
• Middle Aged MeSH
• Humans MeSH
• Brain Death MeSH
• Alcohol Drinking adverse effects   MeSH
• Autopsy MeSH
• Recurrence MeSH
• Heart Arrest * etiology   complications   pathology   therapy   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

Background: Awareness and understanding of organ donation after brain death can significantly influence an individuals' perceptions of the issue. Objectives: The aim of this study was to determine the current level of awareness and perception of the Slovenian public regarding organ donation after brain death. Methods: A cross-sectional study was conducted using a questionnaire to collect data from a sample of 784 individuals. Inferential statistics were conducted using IBM SPSS version 25. Results: The research sample of the studied Slovenian population demonstrated support for organ donation after brain death, despite a relatively low level of awareness of the topic. Significant demographic differences emerged in respondents' perceptions of organ donation. Female respondents, individuals with higher levels of educational attainment, and those working in health and social care exhibited more positive attitudes. In contrast, the age group of 50 years and above obtained the lowest scores. Statistically significant differences in awareness levels were only observed among different work sectors, with individuals working in health and social care showing higher levels of awareness. A positive yet weak correlation was found between the awareness and perceptions regarding the topic. Conclusion: Raising public awareness is essential for promoting organ donation. This can be achieved through the dissemination of information on the subject by experienced professionals.

• MeSH
• Brain Death MeSH
• Population Characteristics MeSH
• Attitude MeSH
• Surveys and Questionnaires MeSH
• Statistics as Topic MeSH
• Public Opinion * MeSH
• Tissue and Organ Procurement * MeSH
• Knowledge MeSH
• Geographicals
• Slovenia MeSH

A 41-year-old man was admitted to hospital due to sudden loss of consciousness. A regional brain perfusion SPECT/low-dose CT showed abnormal 99m Tc-HMPAO uptake in the right hemisphere frontotemporally without any other supratentorial or infratentorial radiotracer uptake. A neuropathological examination disclosed a middle cerebral artery aneurysm. Presumably, vessel wall fibrosis prevented collapse. Multiple transmural dissections of the fibrotic aneurysmal wall were the source of the subarachnoid hemorrhage. This interesting image shows that radiotracer accumulation in cerebral artery aneurysms can be a diagnostic pitfall in brain death scintigraphy assessment.

• MeSH
• Biological Transport MeSH
• Adult MeSH
• Humans MeSH
• Brain * diagnostic imaging   MeSH
• Brain Death * diagnostic imaging   MeSH
• Neuroimaging MeSH
• Single Photon Emission Computed Tomography Computed Tomography MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

BACKGROUND: While 4 randomized controlled clinical trials confirmed the early benefits of hypothermic oxygenated machine perfusion (HOPE), high-level evidence regarding long-term clinical outcomes is lacking. The aim of this follow-up study from the HOPE-ECD-DBD trial was to compare long-term outcomes in patients who underwent liver transplantation using extended criteria donor allografts from donation after brain death (ECD-DBD), randomized to either HOPE or static cold storage (SCS). METHODS: Between September 2017 and September 2020, recipients of liver transplantation from 4 European centers receiving extended criteria donor-donation after brain death allografts were randomly assigned to HOPE or SCS (1:1). Follow-up data were available for all patients. Analyzed endpoints included the incidence of late-onset complications (occurring later than 6 months and graded according to the Clavien-Dindo Classification and the Comprehensive Complication Index) and long-term graft survival and patient survival. RESULTS: A total of 46 patients were randomized, 23 in both arms. The median follow-up was 48 months (95% CI: 41-55). After excluding early perioperative morbidity, a significant reduction in late-onset morbidity was observed in the HOPE group (median reduction of 23 Comprehensive Complication Index-points [p=0.003] and lower incidence of major complications [Clavien-Dindo ≥3, 43% vs. 85%, p=0.009]). Primary graft loss occurred in 13 patients (HOPE n=3 vs. SCS n=10), resulting in a significantly lower overall graft survival (p=0.029) and adverse 1-, 3-, and 5-year survival probabilities in the SCS group, which did not reach the level of significance (HOPE 0.913, 0.869, 0.869 vs. SCS 0.783, 0.606, 0.519, respectively). CONCLUSIONS: Our exploratory findings indicate that HOPE reduces late-onset morbidity and improves long-term graft survival providing clinical evidence to further support the broad implementation of HOPE in human liver transplantation.

• MeSH
• Humans MeSH
• Brain Death MeSH
• Follow-Up Studies MeSH
• Perfusion methods   MeSH
• Graft Survival MeSH
• Liver Transplantation * adverse effects   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Randomized Controlled Trial MeSH