Smrt mozku

doc. MUDr. Svatopluk Ostrý, Ph.D., prof. MUDr. Štefan Sivák, PhD.

Neurol. praxi. 2025;26(2):95

The history of defining and determining death

prof. MUDr. Egon Kurča, PhD., FESO, prof. MUDr. Štefan Sivák, PhD.

Neurol. praxi. 2025;26(2):97-102 | DOI: 10.36290/neu.2024.086

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...

Diagnosis of Brain Death in the Czech and Slovak Republics and Its Preconditions and Contraindications

prof. MUDr. Štefan Sivák, PhD., doc. MUDr. Eva Pokorná, CSc.,CETC, doc. MUDr. Svatopluk Ostrý, Ph.D., MUDr. Petr Hollý, MUDr. Denisa Osinová, PhD., doc. MUDr. Juraj Miklušica, PhD., prof. MUDr. Egon Kurča, PhD., FESO

Neurol. praxi. 2025;26(2):103-108 | DOI: 10.36290/neu.2025.006

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.

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

MUDr. Petr Hollý, MUDr. Zdeněk Kunáš, doc. MUDr. Eva Pokorná, CSc., prof. MUDr. Štefan Sivák, PhD., MUDr. Denisa Osinová, doc. MUDr. Juraj Miklušica, PhD., doc. MUDr. Svatopluk Ostrý, Ph.D.

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

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...

Ancillary electrophysiological examination in determination of brain death

doc. MUDr. Svatopluk Ostrý, Ph.D., doc. MUDr. Irena Holečková, Ph.D., prof. MUDr. Štefan Sivák, PhD., prof. MUDr. Egon Kurča, PhD., FESO, doc. MUDr. Vladimír Nosáľ, PhD., FESO, prof. MUDr. Ivana Štětkářová, CSc., MHA

Neurol. praxi. 2025;26(2):117-121 | DOI: 10.36290/neu.2024.082

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...

Brain death diagnosis and the role of diagnostic imaging

MUDr. Martin Vorčák, Ph.D., MUDr. Hubert Poláček, PhD., MUDr. Zuzana Gešvandtner Trabalková, MPH, MUDr. Daniel Evin, PhD., MUDr. Martin Števík, PhD., doc. MUDr. Kamil Zeleňák, PhD., FCIRSE

Neurol. praxi. 2025;26(2):122-128 | DOI: 10.36290/neu.2025.005

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,...

A new perspective on the generalized myasthenia gravis (gMG) treatment

MUDr. Ivan Martinka, PhD.

Neurol. praxi. 2025;26(2):129-134 | DOI: 10.36290/neu.2024.077

Generalized myasthenia gravis (gMG) is a severe disease leading to risk of immediate life threatening and/or quality of life reduction in case of missing treatment. Even with an excellent therapeutic effect of conventional treatment, the treatment itself can lead to patient's quality of life worsening through unpleasant and/or serious adverse effects (AEs). Currently, in the latest recommendations for the gMG treatment, there is a very striking effort to identify patients with highly active gMG in whom early treatment escalation is needed in order to induce rapid gMG symptoms control and quality of life improvement, preferably with as little frequency...

Prodromal Parkinson's disease - making the diagnosis in the premotor stage

doc. MUDr. Petr Dušek, Ph.D.

Neurol. praxi. 2025;26(2):135-141 | DOI: 10.36290/neu.2025.002

Prodromal Parkinson's disease (PD) manifests with a wide range of clinical symptoms and biological markers, including autonomic nervous system dysfunction, neuropsychiatric symptoms, sleep disorders, hypomimia, and dysarthria. Ultrasound and scintigraphic examinations, genetic variants (e.g., GBA1, LRRK2), and detection of pathological α-synuclein provide valuable diagnostic tools for early identification of at-risk individuals. Despite advancements in diagnostics, effective treatment for the prodromal stage is unavailable, raising ethical questions regarding prognosis communication and patient support. Future research is expected to focus on...

Relationship between headaches and sleep

MUDr. Petra Migaľová

Neurol. praxi. 2025;26(2):142-146 | DOI: 10.36290/neu.2024.079

Sleep is a basic human need, almost half of the human population suffers from its disorder. Headache is one of the most common health problems. According to the WHO, 50-75 % of adults suffer from it. Both of these phenomena have the character of a global health burden. The relationship between headache and sleep disorder is multifaceted and complex, the comorbidity of these two syndromes leads to the chronification of both diseases, increases the burden and leads to the worsening of both disorders, a decrease in the quality of life, an increase in the frequency of complications and a decrease in the effectiveness of treatment.

Biting the bullet: Errors in electroencephalography (EEG)

doc. MUDr. Zdeněk Vojtěch, Ph.D.

Neurol. praxi. 2025;26(2):147-153 | DOI: 10.36290/neu.2024.056

In this article, we want to highlight the causes of the most frequent mistakes in indications and descriptions of EEG findings, both generally and specifically in seizure disorders and encephalopathies. We refer to the mistakes in descriptions and interpretations we most frequently see in our practice. We want to open the discussion about how to minimalize these mistakes in Czech environment.

The potential of artificial intelligence in the diagnosis and treatment of neurological diseases

prof. MUDr. David Školoudík, Ph.D.

Neurol. praxi. 2025;26(2):154-162 | DOI: 10.36290/neu.2024.065

Although the idea of artificial intelligence (AI) can be found as early as the ancient philosophers, it is only the development of computing technology in recent decades that has enabled the practical development of AI. In recent decades, AI has begun to make a significant impact in many fields, including medicine, not least neurology. AI is currently being tested in diagnosis and treatment planning for many neurological diseases. In particular, the use of AI in evaluating neuroimaging findings seems promising. AI is being tested in the diagnosis and treatment of neurodegenerative diseases, especially Alzheimer's dementia, diagnosis and treatment of...

Modifiable risk factors for dementia

RNDr. Mgr. Kateřina Veverová, Ph.D., MUDr. Julie Martínková Nováková, MUDr. Juraj Sečník, Ph.D., MUDr. Jakub Šteiner, MUDr. Simona Karamazovová, Mgr. Zuzana Chmátalová, Ph.D., MUDr. Ondřej Lerch, Ph.D.

Neurol. praxi. 2025;26(2):163-168 | DOI: 10.36290/neu.2025.040

The number of dementia cases is increasing globally. Currently, more than 55 million people worldwide are living with dementia, and according to the World Health Organization, this number is expected to more than double in the next 30 years. Dementia thus represents a significant global health challenge. The 2024 Lancet Commission report identified 14 modifiable risk factors, the elimination of which could potentially prevent up to 45 % of dementia cases. These key risk factors include low education, hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol...

Spinal muscular atrophy and its differential diagnosis. A patient's case report and his journey to diagnosis

MUDr. Olesja Parmová, Ph.D.

Neurol. praxi. 2025;26(2):169-174 | DOI: 10.36290/neu.2025.023

Spinal muscular atrophy (SMA) is a hereditary neuromuscular disease characterized by degeneration of motor neurons, leading to muscle weakness and atrophy. Differential diagnosis of SMA can be challenging due to the same or similar symptoms with other neuromuscular diseases, leading to misinterpretation of disease symptoms and delayed diagnosis. We present a case report of a patient with spinal muscular atrophy who had been waiting for a correct diagnosis for 43 years.