Eye opening in brain death

Santamaría, Joan; Orteu, Nuria; Iranzo, Alejandro; Tolosa, Eduardo

doi:10.1007/s004150050439

Cited by 20 publications

(19 citation statements)

References 5 publications

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“…These included single reports of facial myokymia, transient bilateral finger tremor, repetitive leg movements, ocular microtremor, and cyclical constriction and dilatation in light-fixed pupils. [16][17][18][19][20][21] One Class III study of 144 patients pronounced brain dead found 55% (95% confidence interval [CI] 47-63) of patients had retained plantar reflexes, either flexion or "stimulation induced undulating toe flexion." 22 Another study documented plantar flexion and flexion synergy bilaterally that persisted for 32 hours after the determination of brain death.…”

Section: Analysis Of Evidencementioning

confidence: 99%

Evidence-based guideline update: Determining brain death in adults

Wijdicks¹,

Varelas²,

Gronseth³

et al. 2010

Neurology

936

775

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Objective:To provide an update of the 1995 American Academy of Neurology guideline with regard to the following questions: Are there patients who fulfill the clinical criteria of brain death who recover neurologic function? What is an adequate observation period to ensure that cessation of neurologic function is permanent? Are complex motor movements that falsely suggest retained brain function sometimes observed in brain death? What is the comparative safety of techniques for determining apnea? Are there new ancillary tests that accurately identify patients with brain death?Methods: A systematic literature search was conducted and included a review of MEDLINE and EMBASE from January 1996 to May 2009. Studies were limited to adults (aged 18 years and older). Results and recommendations:In adults, there are no published reports of recovery of neurologic function after a diagnosis of brain death using the criteria reviewed in the 1995 American Academy of Neurology practice parameter. Complex-spontaneous motor movements and falsepositive triggering of the ventilator may occur in patients who are brain dead. There is insufficient evidence to determine the minimally acceptable observation period to ensure that neurologic functions have ceased irreversibly. Apneic oxygenation diffusion to determine apnea is safe, but there is insufficient evidence to determine the comparative safety of techniques used for apnea testing. There is insufficient evidence to determine if newer ancillary tests accurately confirm the cessation of function of the entire brain. Neurology

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Section: Analysis Of Evidencementioning

confidence: 99%

Evidence-based guideline update: Determining brain death in adults

Wijdicks¹,

Varelas²,

Gronseth³

et al. 2010

Neurology

936

775

View full text Add to dashboard Cite

show abstract

“…Another report is by Santamaria and colleagues who described a BD HBC with either spontaneous or elicited left eyelid opening and closing that persisted for nine days before 34 . Diagnosis of BD was supported by somatosensory evoked potentials and technetium-99-m-cerebral gammagraphy.…”

Section: Clinical Evidence From Case Reports Case Series and Cohort mentioning

confidence: 99%

Movements in Brain Death: A Systematic Review

Saposnik

Basile

Young

2009

Can. j. neurol. sci.

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Brain death is the irreversible lost of function of the brain including the brainstem. The presence of spontaneous or reflex movements constitutes a challenge for the neurological determination of death. We reviewed historical aspects and practical implications of the presence of spontaneous or reflex movements in individuals with brain death and postulated pathophysiological mechanisms. We identified and reviewed 131 articles on movements in individuals with confirmed diagnosis of brain death using Medline from January 1960 until December 2007, using ‘brain death’ or ‘cerebral death’ and ‘movements’ or ‘spinal reflex’ as search terms. There was no previous systematic review of the literature on this topic. Plantar withdrawal responses, muscle stretch reflexes, abdominal contractions, Lazarus's sign, respiratory-like movements, among others were described. For the most part, these movements have been considered to be spinal reflexes. These movements are present in as many as 40-50% of heart-beating cadavers. Although limited information is available on the determinants and pathophysiological mechanisms of spinal reflexes, clinicians and health care providers should be aware of them and that they do not preclude the diagnosis of brain death or organ transplantation.

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“…High cervical cord injury, fulminant Guillain-Barré-syndrome, organophosphate intoxication, baclofen toxicity, lidocaine toxicity, and delayed vecuronium clearance have all been reported as clinical mimics of brain death [7,[11][12][13][14][15][16][17][18]. Neurological findings such as absent brainstem reflexes [15], even including unresponsive pupils [17], may occur temporarily and may present as a false positive sign for the examining physician, particularly if they are not accustomed to performing full neurological and brain death examinations.…”

Section: Clinical Examinationmentioning

confidence: 99%

“…Clinical observations in the cranial nerve distribution include facial myokymias, transient eyelid opening, ocular microtremor, and cyclic pupillary constriction and dilatation in light fixed pupils [18][19][20]. The exact origin of such movements is often unclear.…”

Section: Clinical Examinationmentioning

confidence: 99%

“…In the case of a patient without evidence of brainstem function, but slow eye opening in response to painful stimulation of the ipsilateral nipple, the authors hypothesized that the eyelid opening may have been a mere function of Muller's muscle rather than a reflection of brainstem function. The eyelid opening persisted for 9 days before the patient succumbed to asystole [18]. In the case of a patient with absent brainstem reflexes apart from unequal light-fixed pupils which displayed independent periodic constriction and dilatation, it was felt that this was likely not a central process due to the asynchrony.…”

Section: Clinical Examinationmentioning

confidence: 99%

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Pitfalls in the Diagnosis of Brain Death

Busl

Greer

2009

Neurocrit Care

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Since the establishment of the concept of declaring death by brain criteria, a large extent of variability in the determination of brain death has been reported. There are no standardized practical guidelines, and major differences exist in the requirements for the declaration of brain death throughout the USA and internationally. The American Academy of Neurology published evidence-based practice parameters for the determination of brain death in adults in 1995, requiring the irreversible absence of clinical brain function with the cardinal features of coma, absent brainstem reflexes, and apnea, as well as the exclusion of reversible confounders. Ancillary tests are recommended in cases of uncertainty of the clinical diagnosis. Every step in the determination of brain death bears potential pitfalls which can lead to errors in the diagnosis of brain death. These pitfalls are presented here, and possible solutions identified. Suggestions are made for improvement in the standardization of the declaration of brain death.

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Eye opening in brain death

Cited by 20 publications

References 5 publications

Evidence-based guideline update: Determining brain death in adults

Evidence-based guideline update: Determining brain death in adults

Movements in Brain Death: A Systematic Review

Pitfalls in the Diagnosis of Brain Death

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