Organ donationFrequency of spinal reflex movements in brain-dead patients
Section snippets
Materials and methods
The spinal reflexes of patients who were diagnosed as brain dead in our department were examined prospectively between January 2000 and March 2003. Clinical brain death was diagnosed according to the national law requiring the confirmation of irreversible coma, absence of brainstem reflexes, and a positive apnea test in a normothermic, nondrugged patient. Laboratory tests were performed in all subjects to exclude metabolic causes of coma. Confirmatory tests are optional according to these
Results
During the study period, 134 patients met the criteria for brain death. Their mean age was 39.1 ± 24.6 years (range, 2 to 71). Forty-three patients had intracerebral hemorrhage; 42, traumatic brain injury; 18, subarachnoid hemorrhage; 11, cerebral infarct; 8, postcardiac arrest; 4, intoxication; 4, bleeding into a brain tumor; and 4, CNS infection. In 18 of the 134 brain-death patients (13.4%), spinal reflex movements were observed during the study period. The average age of the patients with
Discussion
The process of brain death diagnosis takes hours.4 During this period, some unexpected movements, considered spinal reflexes, are occasionally observed. These movements originate from spinal cord neurons and do not preclude the diagnosis of brain death. After brain death occurs, spinal cord functions can be histologically normal or may have pathologies ranging from edema to necrosis due to ischemic events.5
In several studies, the frequency of spinal reflexes in brain-dead patients has been
References (8)
Spinal reflexes in cerebral brain death
Neurology
(1973)Spinal man after brain death. The unilateral extension-pronation reflex of the upper limbs as an indication of brain death
Acta Neurochir
(1973)Unusual spontaneous movements in brain-dead patients
Neurology
(1984)- Practice parameters for determining brain death in adults: report of the Quality Standarts subcommittee of the American...
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Hepatic Transplantation
2019, Shackelford's Surgery of the Alimentary Tract: 2 Volume SetFactors Delaying Organ Procurement After Declaration of Brain Death in Korea
2016, Transplantation ProceedingsEffectiveness of tail-first dry electrical stunning, followed by immersion in ice water as a slaughter (killing) procedure for turbot (Scophthalmus maximus) and common sole (Solea solea)
2016, AquacultureCitation Excerpt :Positive responses to noxious stimuli were observed for only up to 5 min after LS, whereas the tap response remained active in some fish for up to 75 min. To what extent the tap response can be used to indicate (ability to regain) consciousness is uncertain (EFSA, 2009c), as it is well known that spontaneous or reflex movements can occur even in “brain-dead” human patients (Döşemeci et al., 2004; Jain and DeGeorgia, 2005). It should be noted that a distinction must be made between willful movements, involving the function of higher brain areas, and reflexes being involuntary, purposeful responses to stimuli involving integration in the spinal cord or brainstem.
Electrophysiological and behavioural responses of turbot (Scophthalmus maximus) cooled in ice water
2015, Physiology and BehaviorCitation Excerpt :We previously found that both turbot and sole immersed in ice water after electrical stunning were more responsive to vibration (tapping) than to needle scratches [18]. It is not clear to which extent the tap response may indicate consciousness, since spontaneous or reflex movements can occur even in “brain-dead” human patients [19,20,21]. Heart rate is often measured as a response to stressors and may show tachycardia (increased heart rate) or bradycardia (decreased heart rate).
Movements after brain death
2015, Medicina IntensivaAssessment of Brain Death in the Neurocritical Care Unit
2013, Neurosurgery Clinics of North AmericaCitation Excerpt :It has been postulated that it is the absence of cortical inhibitory and modulatory afferents to spinal cord centers that allows for the activation of basic spinal cord sequences, causing the reflex movements commonly seen in brain death.37 In addition to spinal reflexes,38,39 movements after death have been described during apnea testing and during organ procurement, as well as in the morgue.35,40,41 Movements can manifest in the head, neck, upper and lower extremities, and the trunk, and have been named “Lazarus signs” for their biblical connotation.33,39,42