Variability of Brain Death Determination Guidelines in Leading Us Neurologic Institutions

Machado, Calixto; Lin, K.-C.; Kuo, J.-R.; Greer, D. M.; Varelas, P. N.; Haque, S.; Wijdicks, Eelco F. M.

doi:10.1212/01.wnl.0000334352.27463.49

Cited by 7 publications

(9 citation statements)

References 4 publications

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“…25 Vertebral body destruction with kyphosis associated with segmental instability can be seen in patients with spinal epidural abscess due to concurrent osteomyelitis. 11,15,54 The exact magnitude of compression and distortion of the epidural space and impediment posed to catheter manipulation remains unknown. Engorgement of the epidural venous plexus may be seen occasionally with spinal epidural abscess and may cause an impediment to catheter manipulation.…”

Section: Discussionmentioning

confidence: 99%

Catheter-Based Trans-Epidural Approach to Aspirate Cervical and Thoracic Epidural Abscesses: A Cadaveric Feasibility Study

Qureshi

Malik

et al. 2015

J Neurol Surg A Cent Eur Neurosurg

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Section: Discussionmentioning

confidence: 99%

Catheter-Based Trans-Epidural Approach to Aspirate Cervical and Thoracic Epidural Abscesses: A Cadaveric Feasibility Study

Qureshi

Malik

et al. 2015

J Neurol Surg A Cent Eur Neurosurg

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“…The National Commission for the Determination and Certification of Death has accepted a neurological view of death and emphasized that any legislation of death should be completely separated from any norm governing organ transplants. 49–52 Hence, the Commission enumerated three possible situations for diagnosing death: Outside the intensive care environment (without life support), physicians apply the cardio-circulatory and respiratory criteria.In forensic medicine circumstances, physicians utilize cadaveric signs. (They do not even need a stethoscope.…”

Section: Diagnosis Of Brain Deathmentioning

confidence: 99%

“…According to the Commission, there is only one kind of death, based on the irreversible loss of brain functions. 1,48–52 …”

Section: Diagnosis Of Brain Deathmentioning

confidence: 99%

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Diagnosis of brain death

Machado

2010

Neurol Int

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Brain death (BD) should be understood as the ultimate clinical expression of a brain catastrophe characterized by a complete and irreversible neurological stoppage, recognized by irreversible coma, absent brainstem reflexes, and apnea. The most common pattern is manifested by an elevation of intracranial pressure to a point beyond the mean arterial pressure, and hence cerebral perfusion pressure falls and, as a result, no net cerebral blood flow is present, in due course leading to permanent cytotoxic injury of the intracranial neuronal tissue. A second mechanism is an intrinsic injury affecting the nervous tissue at a cellular level which, if extensive and unremitting, can also lead to BD. We review here the methodology of diagnosing death, based on finding any of the signs of death. The irreversible loss of cardio-circulatory and respiratory functions can cause death only when ischemia and anoxia are prolonged enough to produce an irreversible destruction of the brain. The sign of such loss of brain functions, that is to say BD diagnosis, is fully reviewed.

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“…Confounds such as complex movements which may be intentional, seizure, reflexes, or automatisms, with varying treatments and outcomes, (Han et al, 2006;Saposnik et al, 2005) contribute to DoC misdiagnosis in 46% of adults (Schnakers et al, 2009). Higher missed-or-no DoC diagnosis in neonates due to less-informed DoC DoC definitions, validated exam markers, and diagnostics (Giacino et al, 2018;Nakagawa et al, 2012;Bruno et al, 2011;Schnakers et al, 2009;Machado, 2008) likely reduces precision in diagnosis-informed treatments, outcome predictions, and WLST determinations (Pant, 2021;Downar et al, 2016;Turgeon et al, 2011;Devictor et al, 2008) .…”

Section: Introductionmentioning

confidence: 99%

Association of Network Connectivity via Resting State Functional MRI with Consciousness, Mortality, and Outcomes in Neonatal Acute Brain Injury

Boerwinkle

Sussman

Manjón

et al. 2021

Preprint

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Background An accurate and comprehensive test of integrated brain network function is needed for neonates during the acute brain injury period to inform on morbidity. This retrospective cohort study aimed to assess whether integrated brain network function by resting state functional MRI, acquired during the acute period in neonates with brain injury, is associated with acute exam, neonatal mortality, and 5-month outcomes. Methods This study included 40 consecutive neonates with resting state functional MRI acquired 1-22 days after suspected brain insult from March 2018 to July 2019 at Phoenix Childrens Hospital. Acute period exam and test results were assigned ordinal scores based on severity as documented by respective treating specialists. Analyses (Fisher exact, Wilcoxon-rank sum test, ordinal/multinomial logistic regression) examined association of resting state networks with demographics, presentation, neurological exam, electroencephalogram, anatomical MRI, magnetic resonance spectroscopy, passive task functional MRI, and outcomes of discharge condition, outpatient development, motor tone, seizure, and mortality. Results Subjects had a mean (standard deviation) gestational age of 37.8 (2.6) weeks, a majority were male (63%), with diagnosis of hypoxic ischemic encephalopathy (68%). Other findings at birth included mild distress (48%), moderately abnormal neurological exam (33%), and consciousness characterized as awake but irritable (40%). Significant associations after multiple testing corrections were detected for resting state networks: basal ganglia with outpatient developmental delay (odds ratio [OR], 14.5; 99.4% confidence interval [CI], 2.00-105; P<.001) and motor tone/weakness (OR, 9.98; 99.4% CI, 1.72-57.9; P<.001); language/frontal-parietal network with discharge condition (OR, 5.13; 99.4% CI, 1.22-21.5; P=.002) and outpatient developmental delay (OR, 4.77; 99.4% CI, 1.21-18.7; P=.002); default mode network with discharge condition (OR, 3.72; 99.4% CI, 1.01-13.78; P=.006) and neurological exam (P=.002 (FE); OR, 11.8; 99.4% CI, 0.73-191; P=.01 (OLR)); seizure onset zone with motor tone/weakness (OR, 3.31; 99.4% CI, 1.08-10.1; P=.003). Resting state networks were not detected in only three neonates, who died prior to discharge. Conclusions This study provides level 3 evidence (OCEBM Levels of Evidence Working Group) that the degree of abnormality of resting state networks in neonatal acute brain injury is associated with acute exam and outcomes. Total lack of brain network detection was only found in patients who did not survive.

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Variability of Brain Death Determination Guidelines in Leading Us Neurologic Institutions

Cited by 7 publications

References 4 publications

Catheter-Based Trans-Epidural Approach to Aspirate Cervical and Thoracic Epidural Abscesses: A Cadaveric Feasibility Study

Catheter-Based Trans-Epidural Approach to Aspirate Cervical and Thoracic Epidural Abscesses: A Cadaveric Feasibility Study

Diagnosis of brain death

Association of Network Connectivity via Resting State Functional MRI with Consciousness, Mortality, and Outcomes in Neonatal Acute Brain Injury

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