Neurol. praxi. 2025;26(2):109-116 | DOI: 10.36290/neu.2024.078

Clinical determination of brain death - methodology of neurological examination and apnea test

MUDr. Petr Hollý1, 2, 3, MUDr. Zdeněk Kunáš3, doc. MUDr. Eva Pokorná, CSc.4, prof. MUDr. Štefan Sivák, PhD.5, MUDr. Denisa Osinová6, doc. MUDr. Juraj Miklušica, PhD.7, doc. MUDr. Svatopluk Ostrý, Ph.D.3, 8
1 Neurologická klinika a Centrum klinických neurověd 1. lékařské fakulty Univerzity Karlovy a Všeobecné fakultní nemocnice v Praze
2 Ústav soudního lékařství a toxikologie 1. lékařské fakulty Univerzity Karlovy a Všeobecné fakultní nemocnice v Praze
3 Neurologické oddělení, Nemocnice České Budějovice, a. s., České Budějovice
4 Odborné edukační pracoviště pro dárcovství orgánů, Institut klinické a experimentální medicíny, Praha
5 Neurologická klinika, Jesseniova lekárska fakulta UK v Martine a Univerzitná nemocnica Martin, Martin
6 Klinika anesteziológie a intenzívnej medicíny, Jesseniova lekárska fakulta UK v Martine a Univerzitná nemocnica Martin, Martin
7 Klinika všeobecnej, viscerálnej a transplantačnej chirurgie, Univerzita Komenského v Bratislave, Jesseniova lekárska fakulta UK, Bratislava
8 Neurochirurgická a Neuroonkologická klinika, 1. lékařská fakulta, Univerzita Karlova v Praze a Ústřední vojenská nemocnice - Vojenská fakultní nemocnice, Praha

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: brain death, neurological examination, apnea test, brain stem function, brain stem reflexes.

Received: September 14, 2024; Revised: November 17, 2024; Accepted: November 20, 2024; Prepublished online: November 20, 2024; Published: May 5, 2025  Show citation

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Hollý P, Kunáš Z, Pokorná E, Sivák Š, Osinová D, Miklušica J, Ostrý S. Clinical determination of brain death - methodology of neurological examination and apnea test. Neurol. praxi. 2025;26(2):109-116. doi: 10.36290/neu.2024.078.

Legenda k videozáznamům

Souhrnná poznámka: Význam videozáznamu je nejen dokumentační, ale i pro samotné vyhodnocení testu. Umožňuje vyšetřujícímu se k záznamu vrátit, opakovaně si jej přehrát, zvětšit, zpomalit, vytvořit smyčku. To přispěje ke zpřesnění vyhodnocení reflexu. Užívání pomocných mechanismů zpřesní diagnostiku (vylepení horních víček a užití fyziologického roztoku při vyšetření korneálního reflexu, označení meridiánu oka při vyšetření okulocefalického či okulovestibulárního reflexu atd.). Zkratky: DK: dolní končetina/y; HK: horní končetina/y; TM kloub: temporomandibulární kloub.

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