Estudo do reflexo vestíbulo-ocular (RVO) Prova Calórica (PC) no diagnóstico de morte encefálica
AUTOR(ES)
Elienai de Alencar Meneses
DATA DE PUBLICAÇÃO
2008
RESUMO
The revision of the death concept, based on the concept of brain death became necessary as a consequence of the scientific evolution and the development of the medical sciences. However the major cause of impacts and fomentations of ethical challenges in the scientific community was the fact of the growing need for organs transplants, forcing the creation of laws, protocols, parameters and criteria for redefinition of the concept of death. The concept of brain death is the total loss of function of the brain and brainstem with known causes. The brain stem is an integrative essential part of all vital functions, and the evaluation of the its function by the vestibulo ocular reflex (VOR) through caloric test, is described in all protocols, parameters and criteria of neurological clinical evaluation of the patient in coma and in the clinical diagnosis of brain death. This study evaluates the predictive value of caloric test in the diagnosis of brain death, analyzing the responses of VOR in patient in coma, comparing the incidence rates of recovery, vegetative state and death of patients in coma with VOR present and absent. We studied 60 patients in coma by known cause, with score equal to or less than 8, based on the Glasgow coma scale, with 49 male patients and 11 female.with age from 7 to 83 years. The main causes of coma were: head injury in 28 patients, stroke in 18 patients and in 14 patients coma was determined by other causes (spinal trauma, multiple trauma, meningitis, hydrocephaly, cardiac and respiratory arrest and cerebral hypoperfusion after septic or hypovolemic shock. The caloric tests of the study group (60 patients) were divided into 2 categories: 30 patients with vestibulo Ocular Reflex (VOR) present and 30 patients with (VOR) absent. Both groups were followed, to determine the outcomes: recovery, vegetative state or death. Among those 30 patients who had VOR present, 19 had combined ocular deviation to side stimulated and were classified as (VOR) present and normal, 11 patients had disconjugate ocular deviation, or slow movement, irregular and were classified as: (VOR) present altered. The 30 patients with RVO absent were those who showed no eye movement. The group of patients with normal VOR showed better prognosis, recovery (42%), vegetative state (37%) and death (21%). The group with VOR present altered and the group with VOR absent, had worse prognosis: death 73%, vegetative state 18% and recovery 9%, whereas the group with VOR absent, all had death as an outcome (100%).
ASSUNTO(S)
reflexo vestíbulo ocular- rvo prova calórica em pacientes em coma ciencias da saude rvo no diagnóstico de morte encefálica prova calórica
