Reader response: Determination of death by neurologic criteria around the world
CalixtoMachado, Neurologist, AAN Corresponding Fellow, Institute of Neurology and Neurosurgery (Havana, Cuba)
Submitted July 02, 2020
Lewis et al.1 developed the largest and most complete assessment ever performed for identifying similarities and differences in protocols on determination of brain death/death by neurologic criteria (BD/DNC). The authors found substantial variability in protocols, which might partially explain why quarrelsome braindead cases have recently raised up new disputes on accepting BD.2,3
The presence of primary posterior fossa lesions enforces the needs of “aligning the criterion and tests for brain death.”4 In some patients fulfilling clinical BD criteria, when a posterior fossa lesion does not provoke an important increment of intracranial pressure, there may be not a full absence of cerebral blood flow, explaining preservation of EEG activity, evoked potentials, and autonomic function in some cases.3
Some authors commented that in the case of isolated brainstem lesions, sparing the mesopontine tegmental reticular formation, this condition would theoretically lead to a fully apneic locked-in syndrome—which imitates brainstem death—with the possibility of retaining some degree of consciousness for some time, even fulfilling clinical BD criteria.5 This was the case in Jahi McMath.3
Further research and discussion are necessary concerning the use or not of ancillary tests in BD diagnosis, in the presence of primary posterior fossa lesions.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Lewis A, Bakkar A, Kreiger-Benson E, et al. Determination of death by neurologic criteria around the world. Neurology 2020 Epub Jun 23.
Lewis A. Reconciling the Case of Jahi McMath. Neurocrit Care 2018;29:20–22.
Machado C. Jahi McMath: a new state of disorder of consciousness. J Neurosurg Sci 2020 Epub May 13.
Bernat JL, Dalle Ave AL. Aligning the Criterion and Tests for Brain Death. Camb Q Healthc Ethics 2019;28:635–641.
Walter U, Fernandez-Torre JL, Kirschstein T, Laureys S. When is "brainstem death" brain death? The case for ancillary testing in primary infratentorial brain lesion. Clin Neurophysiol 2018;129:2451–2465.
Lewis et al.1 developed the largest and most complete assessment ever performed for identifying similarities and differences in protocols on determination of brain death/death by neurologic criteria (BD/DNC). The authors found substantial variability in protocols, which might partially explain why quarrelsome braindead cases have recently raised up new disputes on accepting BD.2,3
The presence of primary posterior fossa lesions enforces the needs of “aligning the criterion and tests for brain death.”4 In some patients fulfilling clinical BD criteria, when a posterior fossa lesion does not provoke an important increment of intracranial pressure, there may be not a full absence of cerebral blood flow, explaining preservation of EEG activity, evoked potentials, and autonomic function in some cases.3
Some authors commented that in the case of isolated brainstem lesions, sparing the mesopontine tegmental reticular formation, this condition would theoretically lead to a fully apneic locked-in syndrome—which imitates brainstem death—with the possibility of retaining some degree of consciousness for some time, even fulfilling clinical BD criteria.5 This was the case in Jahi McMath.3
Further research and discussion are necessary concerning the use or not of ancillary tests in BD diagnosis, in the presence of primary posterior fossa lesions.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References