scholarly journals Atypical Pupil Reactions in Brain Dead Patients

2021 ◽  
Vol 11 (9) ◽  
pp. 1194
Author(s):  
Joanna Sołek-Pastuszka ◽  
Małgorzata Zegan-Barańska ◽  
Jowita Biernawska ◽  
Marcin Sawicki ◽  
Waldemar Iwańczuk ◽  
...  
Keyword(s):  
Brain Death ◽  
Peripheral Nerves ◽  
Pupil Diameter ◽  
Pupillary Dilation ◽  
Neck Flexion ◽  
Routine Diagnosis ◽  
Pupillary Constriction ◽  
Pupil Constriction ◽  
Brain Dead ◽  
Stimulation Of

Background: During routine diagnosis of brain death, changes in pupil diameter in response to the stimulation of peripheral nerves are sometimes observed. For example, pupillary dilation after diagnosed brain death is described in the literature as the ciliospinal reflex. However, pupil constriction creates diagnostic doubts. Objective: The pupillometric analysis of pupil response to stimulation of the cervicothoracic spinal cord in patients with diagnosed brain death. Methods: Instrumental tests to confirm the arrest of cerebral circulation were performed in 30 adult subjects (mean age 53.5 years, range 26–75 years) with diagnosed brain death. In addition, a pupillometer was used to measure the change in pupil diameter in response to neck flexion. Intervention: Flexion of the neck and measuring the response in change of the pupil with the use of the pupillometer. Results: The change in the pupil was observed in the examined group of patients. Difference in pupil size ≥ 0.2 mm was observed in 14 cases (46%). In five cases (17%), pupil constriction was found (from 0.2 to 0.7 mm). Measurement error was +/− 0.1 mm. Conclusions: Both pupillary constriction and dilatation may occur due to a ciliospinal reflex in patients with brain death. This phenomenon needs further research in order to establish its pathophysiology.

Surface anodal stimulation of human peripheral nerves

1988 ◽  
Vol 73 (3) ◽  
pp. 481-488 ◽  
Author(s):  
T. Winkler ◽  
E. St�lberg
Keyword(s):  
Peripheral Nerves ◽  
Anodal Stimulation ◽  
Stimulation Of

Electrical Stimulation of the Spinal Cord and Peripheral Nerves for Pain Control

1981 ◽  
Vol 44 (4) ◽  
pp. 207-217 ◽  
Author(s):  
Don M. Long ◽  
Donald Erickson ◽  
James Campbell ◽  
Richard North
Keyword(s):  
Spinal Cord ◽  
Electrical Stimulation ◽  
Peripheral Nerves ◽  
Pain Control ◽  
Stimulation Of

ANENCEPHALIC ORGAN DONORS

PEDIATRICS ◽  
1989 ◽  
Vol 83 (2) ◽  
pp. A42-A42
Author(s):  
Student
Keyword(s):  
Brain Death ◽  
Low Dose ◽  
Organ Donors ◽  
Policy Choices ◽  
Minute Period ◽  
Definite Time ◽  
Periodic Testing ◽  
Basic Protocol ◽  
Brain Dead ◽  
Canadian Group

[There are] two policy choices: we can abandon attempts to justify use of anencephalic infants as organ donors because there is currently no clinically accepted means to declare brain death in these infants; or we can carry out the research necessary to establish a clinically valid procedure for doing so. A Canadian group has decided to take the second route and experiment on methods to use as organ donors anencephalic newborns who can be validly declared brain-dead on classic criteria. The group has developed a basic protocol that calls for the parents to agree, prior to birth, that: (1) the infant will be resuscitated; (2) periodic testing will be done to determine brain death (removal from the ventilator at six-to-twelve-hour intervals for a ten-minute period to determine ability to breathe spontaneously; (3) organ donation is acceptable; and (4) a definite time limit (to be determined by the parents but not more than fourteen days) after which the infant will be removed from the ventilator and permitted to die. Low-dose morphine is administered to prevent potential suffering on the part of the infant, although whether anencephalic newborns can suffer is unknown.

Brain Death and Organ Donation

2018 ◽  
Author(s):  
Thomas I. Cochrane
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Cardiac Death ◽  
Donation After Cardiac Death ◽  
Donation After Brain Death ◽  
Brain Death Determination ◽  
Brain Dead ◽  
American Academy Of Neurology ◽  
Death Determination

Brain death is the state of irreversible loss of the clinical functions of the brain. A patient must meet strict criteria to be declared brain dead. They must have suffered a known and demonstrably irreversible brain injury and must not have a condition that could render neurologic testing unreliable. If the patient meets these criteria, a formal brain death examination can be performed. The three findings in brain death are coma or unresponsiveness, absence of brainstem reflexes, and apnea. Brain death is closely tied to organ donation, because brain-dead patients represent approximately 90% of deceased donors and thus a large majority of donated organs. This review details a definition and overview of brain death, determination of brain death, and controversy over brain death, as well as the types of organ donation (living donation versus deceased donation), donation after brain death, and donation after cardiac death. A figure presents a comparison of organ donation after brain death and after cardiac death, and a table lists the American Academy of Neurology Criteria for Determination of Brain Death. This review contains 1 highly rendered figure, 3 table, and 20 references.

scholarly journals Brain Death-Induced Inflammatory Activity is Similar to Sepsis-Induced Cytokine Release

2018 ◽  
Vol 27 (10) ◽  
pp. 1417-1424 ◽  
Author(s):  
Patrícia Schwarz ◽  
Geisiane Custódio ◽  
Jakeline Rheinheimer ◽  
Daisy Crispim ◽  
Cristiane B. Leitão ◽  
...  
Keyword(s):  
Brain Death ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Release Kinetics ◽  
Magnetic Bead ◽  
Control Group ◽  
Cytokine Release ◽  
Plasma Cytokine ◽  
Ifn Γ ◽  
Brain Dead

Brain death (BD) is associated with a systemic inflammation leading to worse graft outcomes. This study aimed to compare plasma cytokine values between brain-dead and critically ill patients, including septic and non-septic controls, and evaluate cytokine release kinetics in BD. Sixteen brain-dead and 32 control patients (16 with and 16 without sepsis) were included. Plasma cytokines were measured by magnetic bead assay after the first clinical exam consistent with BD and every 6 hours thereafter, and at the time of study entry in the control group. The values for IL-8 and IFN-γ were higher in brain-dead and septic patients than in non-septic patients [IL-8: 80.3 (18.7–169.6) vs. 68.2 (22.4–359.4) vs. 16.4 (9.2–42.7) pg/mL; P = 0.006; IFN-γ: 2.8 (1.6-6.1) vs. 3.4 (1.2–9.0) vs. 0.5 (0.5–1.8) pg/mL; P = 0.012]. TNF showed a clear tendency to increase in brain-dead patients [2.7 (1.0–4.8) vs. 1.0 (1.0–5.6) vs. 1.0 (1.0–1.0) pg/mL; P = 0.051], and IL-6 values were higher in brain-dead patients than in non-septic controls [174.5 (104.9–692.5) vs. 13.2 (7.3–38.6) pg/mL; P = 0.002]. These differences remained even after excluding brain-dead patients who also had sepsis ( n = 3). IL-1β and IL-10 values increased from baseline to time point 2 (∼6 hours later) [IL-1β: 5.39 (1.93–16.89) vs. 7.11 (1.93–29.13) pg/mL; P = 0.012; IL-10: 8.78 (3.62–16.49) vs. 15.73 (5.49–23.98) pg/mL; P = 0.009]. BD-induced and sepsis-induced plasma cytokine values were similarly high, and both were higher than the observed in non-septic critically ill patients.

Brain death and transcranial Doppler: Experience in 130 cases of brain dead patients

1998 ◽  
Vol 160 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Xavier Ducrocq ◽  
Marc Braun ◽  
Marc Debouverie ◽  
Christel Junges ◽  
Mireille Hummer ◽  
...  
Keyword(s):  
Brain Death ◽  
Transcranial Doppler ◽  
Brain Dead

Stimulation of peripheral nerves using conductive hydrogel electrodes*

2018 ◽  
Author(s):  
Aaron Gilmour ◽  
Josef Goding ◽  
Ulises Aregueta Robles ◽  
Naomi Staples ◽  
Philip Byrnes-Preston ◽  
...  
Keyword(s):  
Peripheral Nerves ◽  
Conductive Hydrogel ◽  
Stimulation Of

scholarly journals Brain-Dead and Coma Patients Exhibit Different Serum Metabolic Profiles: A Novel Diagnostic Approach in Neurocritical Care

2021 ◽  
Author(s):  
Tomasz Dawiskiba ◽  
Wojciech Wojtowicz ◽  
Badr Qasem ◽  
Marceli Łukaszewski ◽  
Karolina Anna Mielko ◽  
...  
Keyword(s):  
Brain Death ◽  
Neurocritical Care ◽  
Clinical Symptoms ◽  
Proton Nuclear Magnetic Resonance ◽  
Sample Collection ◽  
Serum Samples ◽  
Multivariate Statistical ◽  
Brain Death Diagnosis ◽  
Brain Dead ◽  
Metabolomic Approach

Abstract There is a clear difference between severe brain damage and brain death. However, in clinical practice, the differentiation of these states can be challenging. Currently, there are no laboratory tools that facilitate brain death diagnosis. The aim of our study was to evaluate the utility of serum metabolomic analysis in differentiating coma patients (CP) from individuals with brain death (BD). Serum samples were collected from 23 adult individuals with established diagnosis of brain death and 24 patients in coma with Glasgow Coma Scale 3 or 4, with no other clinical symptoms of brain death for at least 7 days after sample collection. Serum metabolomic profiles were investigated using proton nuclear magnetic resonance (NMR) spectroscopy. The results obtained were examined by univariate and multivariate data analysis (PCA, PLS-DA, and OPLS-DA). Metabolic profiling allowed us to quantify 43 resonance signals, of which 34 were identified. Multivariate statistical modeling revealed a highly significant separation between coma patients and brain-dead individuals, as well as strong predictive potential. The findings not only highlight the potential of the metabolomic approach for distinguishing patients in coma from those in the state of brain death but also may provide an understanding of the pathogenic mechanisms underlying these conditions.

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