Morte Encefálica

Um Diagnóstico Agonizante

Autores

  • Cícero Galli Coimbra

DOI:

https://doi.org/10.34024/rnc.1998.v6.10334

Palavras-chave:

Morte encefálica, penumbra isquêmica, isquemia, hipertensão intracraniana, hipotermia, trombólise

Resumo

A primeira parte deste texto oferece uma breve visão histórica da redefinição de morte como encefálica, com particular enfoque voltado para a crítica direcionada aos critérios correntemente utilizados para o seu diagnóstico, a qual tem sido freqüentemente desconsiderada em revisões pretensamente exaustivas do assunto. Na segunda parte, o autor discute a validade dos mesmos critérios, analisados à luz do fenômeno da penumbra isquêmica, propondo novos conceitos fisiopatológicos, designados como penumbra isquêmica regional e global. Segundo esses conceitos, os critérios em uso corrente não excluem do diagnóstico de morte encefálica os pacientes que se encontrem com o fluxo sangüíneo global ou regionalmente situado na faixa própria da penumbra isquêmica, em conseqüência dos níveis submáximos de hipertensão intracraniana ou de oclusão parcial da artéria basilar. Nesses pacientes, a aplicação do teste da apnéia, em razão da hipotensão arterial severa e do aumento da pressão intracraniana associados a ele, pode determinar colapso irreversível da circulação encefálica, induzindo a morte que deveria apenas diagnosticar. O valor terapêutico da hipotermia moderada e da trombólise intra-arterial, como alternativas éticas e eficientes ao teste da apnéia é discutido.

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Referências

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Publicado

1998-06-30

Como Citar

Coimbra, C. G. (1998). Morte Encefálica: Um Diagnóstico Agonizante. Revista Neurociências, 6(2), 58–68. https://doi.org/10.34024/rnc.1998.v6.10334

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