Subarahnoidalno i intracerebralno krvarenje kod korisnika kokaina
Sažetak
Uvod/Cilj. Kokain je alkaloid iz lišća biljki Erythroxylum coca i Erythroxylum novogranatense. Kokain se u organizam može uneti oralno, intranazalno, intravenski, inhalatorno i intragenitalno. Njegovom zloupotrebom mogu nastati subarahnoidalno i intracerebralno krvarenje. Cilj rada bio je da se prikažu koncentracije kokaina i benzoilekgonina (BZ) u telesnim tečnostima i organima, učestalost subarahnoidalnog i intracerebralnog krvarenja i povezanost tih krvarenja sa koncentracijama kokaina/BZ kod obdukovanih korisnika kokaina. Metode. Ispitivanje je obuhvatilo analizu 26 obdukcionih nalaza sa ustanovljenim prisustvom kokaina i/ili BZ iz baze podataka Instituta za patologiju i forenzičku medicinu Vojnomedicinske akademije u Beogradu, Srbija, za period 2005−2018. godine. Analizirane su vrednosti koncentracija kokaina i BZ u krvi, urinu, želudačnom sadržaju, mozgu, bubrezima i jetri sa žučnom kesom, kao i patohistološki nalaz mozga. Rezultati. Istraživanjem je obuhvaćeno 26 obdukovanih pacijenata starih od 23 do 56 godina (srednja vrednost 33,77 ± 8,52), 20 (75,92%) muškaraca i 6 (23,08%) žena. Toksikološko-hemijskom analizom nađen je kokain u krvi kod 12 (46,15%), u urinu kod 15 (57,69%) i u mozgu kod 8 (30,77%) obdukovanih pacijenata. U krvi je nađen BZ kod 20 (76,92%), u urinu kod 21 (80,77%) i u mozgu kod 10 (38,46%) obdukovanih pacijenata. Subarahnoidalno krvarenje ustanovljeno je kod 10 (38,46%), intracerebralno
krvarenje kod 18 (69,23%), a subarahnoidalno i intracerebralno krvarenje zajedno kod 6 (23,07%) obdukovanih pacijenata. Intracerebralno (fokalno i perivaskularno) krvarenje bilo je češće. Koncentracije kokaina i BZ u telesnim tečnostima i organima kod obdukovanih pacijenata kod kojih je ustanovljeno intracerebralno i subarahnoidalno krvarenje bile su statistički značajno više nego kod onih koji nisu imali krvarenja. Zaključak. Subarahnoidalno i intracrebralno krvarenje su bili često zastupljeni kod obdukovanih pacijenata koji su koristili kokain. Korelacija između subarahnoidnog i intracerebralnog krvarenja i koncentracije kokaina u krvi bila je umerene jačine. Utvrđena je jaka korelacija između subarahnoidalnog i intracerebralnog krvarenja i koncentracija BZ u skoro svim analiziranim uzorcima.
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