| Abstract | Traumatska ozljeda mozga mačaka vrlo je česta posljedica udarca motornih vozila, pada s
visokih visina, ugriza i namjernih ili slučajnih ozljeda uzrokovanih od strane čovjeka.
Predstavlja vrlo ozbiljno i po život opasno stanje koje zahtijeva brzu medicinsku intervenciju.
Trauma glave obuhvaća primarnu i sekundarnu ozljedu mozga. Primarna je uzrokovana
djelovanjem mehaničkih sila prilikom samog udarca te obuhvaća difuznu aksonalnu ozljedu,
kontuzije, krvarenje te laceracije moždanog parenhima. Sekundarna ozljeda mozga
posredovana je brojnim biokemijskim procesima koji se razvijaju nakon traume. Obuhvaća
povećanu aktivnost ekscitatornih neurotransmitera, stvaranje reaktivnih kisikovih spojeva,
proizvodnju proupalnih citokina te razvoj edema mozga. Posljedično tomu, dolazi do povećanja
ICP-a. Kada se kompenzacijski mehanizmi istroše, cerebralna perfuzija postaje ugrožena,
dolazi do ishemije moždanog tkiva te se razvija Cushingov refleks koji uključuje hipertenziju,
bradikardiju i nepravilno disanje. Sistemski čimbenici poput hipotenzije, hipoksije,
hiperglikemije, hipokapnije, hiperkapnije, hipotermije i hipertermije pridonose sekundarnoj
ozljedi mozga.
Prilikom trijaže pacijenta s traumom glave fokus je na ABC protokolu i stabilizaciji
respiratornog i kardiovaskularnog sustava. Nakon toga radi se procjena neurološkog stanja te
određuje MGCS pomoću kojeg se prati stanje pacijenta i procjenjuje uspješnost liječenja.
Dijagnostika se svodi na klinički i neurološki pregled, laboratorijsku analizu krvi te slikovnu
dijagnostiku.
Sistemska stabilizacija uključuje terapiju kisikom, mehaničku ventilaciju, rehidraciju i
postizanje normotenzije. Ograničavanje rasta ICP-a postiže se intrakranijskom stabilizacijom
poput pozicioniranja glave pacijenta pod kutom od 30⁰, hiperosmolarnom terapijom,
analgezijom, regulacijom temperature te dekompresivnom kraniotomijom.
Skale poput Animal Trauma Triage i MGCS korisne su u određivanju prognoze mačaka s
traumom glave. Prema novijim istraživanjima, Koret CT sustav bodovanja te MRI mogu
koristiti kao dodatni prognostički pokazatelji. |
| Abstract (english) | Traumatic brain injury in cats is a common consequence of motor vehicle accidents,
falls from heights, bites, and intentional or accidental injuries caused by humans. It represents
a very serious and life-threatening condition that requires prompt medical intervention.
Head trauma includes both primary and secondary brain injury. The primary injury is
caused by the mechanical forces during the impact itself and includes diffuse axonal injury,
contusions, bleeding, and lacerations of the brain parenchyma. Secondary brain injury is
mediated by numerous biochemical processes that develop after trauma, involving increased
activity of excitatory neurotransmitters, reactive oxygen species formation, proinflammatory
cytokine production, and the development of brain edema. Consequently, intracranial pressure
(ICP) increases. When compensatory mechanisms are exhausted, cerebral perfusion becomes
compromised, leading to ischemia of brain tissue and the development of Cushing's reflex,
which includes hypertension, bradycardia, and irregular breathing. Systemic factors such as
hypotension, hypoxia, hyperglycemia, hypocapnia, hypercapnia, hypothermia, and
hyperthermia contribute to secondary brain injury.
During the triage of a patient with head trauma, the focus is on the ABC protocol and
stabilization of the respiratory and cardiovascular systems. Subsequently, a neurological
assessment is performed, and the Modified Glasgow Coma Scale (MGCS) is used to monitor
the patient's condition and assess the success of treatment.
Diagnosis involves clinical and neurological examinations, blood laboratory analysis,
and imaging diagnostics. Systemic stabilization includes oxygen therapy, mechanical
ventilation, rehydration, and achieving normotension. Limiting ICP growth is achieved through
intracranial stabilization, such as positioning the patient's head at a 30⁰ angle, hyperosmolar
therapy, analgesia, temperature regulation, and decompressive craniotomy.
Scales such as Animal Trauma Triage and MGCS are useful in determining the
prognosis of cats with head trauma. According to recent research, the Koret CT scoring system
and MRI can be used as additional prognostic indicators. |
