An 18-year-old man with anaplastic oligoastrocytoma was pronounced brain dead based on absent confounding factors, absent brainstem reflexes, apnea with CO2 challenge, and isoelectric EEG. Plantar flexion, triple flexion response, and undulation toes were noted bilaterally and remained for 32 hours during organ procurement.
Although in our experience toes and legs in patients declared brain dead are mostly immobile after noxious stimulation or plantar stimulation, one study noted retained flexion reflexes in more than 50% of patients.1 Corticoreticular disconnection may leave disorganized fragments of unisegmental (undulating toes and plantar flexion2) or polysegmental (triple flexion response) spinal reflexes.
Footnotes
Disclosure: The authors report no conflicts of interest.
Supplemental data at www.neurology.org
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
