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Erschienen in: Neurocritical Care 2/2009

01.10.2009 | Review Article

Pitfalls in the Diagnosis of Brain Death

verfasst von: Katharina M. Busl, David M. Greer

Erschienen in: Neurocritical Care | Ausgabe 2/2009

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Abstract

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.
Literatur
1.
Zurück zum Zitat Mollaret P, Goulon M. The depassed coma (preliminary memoir). Rev Neurol (Paris). 1959;101:3–15. Mollaret P, Goulon M. The depassed coma (preliminary memoir). Rev Neurol (Paris). 1959;101:3–15.
2.
Zurück zum Zitat A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA. 1968;205:337–40. doi:10.1001/jama.205.6.337 A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA. 1968;205:337–40. doi:10.​1001/​jama.​205.​6.​337
3.
Zurück zum Zitat Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA. 1981;246:2184–6. doi:10.1001/jama.246.19.2184. Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA. 1981;246:2184–6. doi:10.​1001/​jama.​246.​19.​2184.
4.
Zurück zum Zitat Uniform Brain Death Act. Uniform Laws Annotations 1980;12:2. Uniform Brain Death Act. Uniform Laws Annotations 1980;12:2.
5.
Zurück zum Zitat Wijdicks EF. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology. 2002;58:20–5.PubMed Wijdicks EF. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology. 2002;58:20–5.PubMed
10.
Zurück zum Zitat Practice parameters for determining brain death in adults (summary statement). The Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1995;45:1012–4. Practice parameters for determining brain death in adults (summary statement). The Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1995;45:1012–4.
11.
Zurück zum Zitat Friedman Y, Lee L, Wherrett JR, Ashby P, Carpenter S. Simulation of brain death from fulminant de-efferentation. Can J Neurol Sci. 2003;30:397–404.PubMed Friedman Y, Lee L, Wherrett JR, Ashby P, Carpenter S. Simulation of brain death from fulminant de-efferentation. Can J Neurol Sci. 2003;30:397–404.PubMed
15.
Zurück zum Zitat Richard IH, LaPointe M, Wax P, Risher W. Non-barbiturate, drug-induced reversible loss of brainstem reflexes. Neurology. 1998;51:639–40.PubMed Richard IH, LaPointe M, Wax P, Risher W. Non-barbiturate, drug-induced reversible loss of brainstem reflexes. Neurology. 1998;51:639–40.PubMed
17.
Zurück zum Zitat Stojkovic T, Verdin M, Hurtevent JF, Laureau E, Krivosic-Horber R, Vermersch P. Guillain-Barre syndrome resembling brainstem death in a patient with brain injury. J Neurol. 2001;248:430–2. doi:10.1007/s004150170190.PubMedCrossRef Stojkovic T, Verdin M, Hurtevent JF, Laureau E, Krivosic-Horber R, Vermersch P. Guillain-Barre syndrome resembling brainstem death in a patient with brain injury. J Neurol. 2001;248:430–2. doi:10.​1007/​s004150170190.PubMedCrossRef
25.
Zurück zum Zitat Ivan LP. Spinal reflexes in cerebral death. Neurology. 1973;23:650–2.PubMed Ivan LP. Spinal reflexes in cerebral death. Neurology. 1973;23:650–2.PubMed
26.
Zurück zum Zitat Saposnik G, Bueri JA, Maurino J, Saizar R, Garretto NS. Spontaneous and reflex movements in brain death. Neurology. 2000;54:221–3.PubMed Saposnik G, Bueri JA, Maurino J, Saizar R, Garretto NS. Spontaneous and reflex movements in brain death. Neurology. 2000;54:221–3.PubMed
28.
Zurück zum Zitat Ropper AH. Unusual spontaneous movements in brain-dead patients. Neurology. 1984;34:1089–92.PubMed Ropper AH. Unusual spontaneous movements in brain-dead patients. Neurology. 1984;34:1089–92.PubMed
30.
Zurück zum Zitat Jorgensen EO. Spinal man after brain death. The unilateral extension-pronation reflex of the upper limb as an indication of brain death. Acta Neurochir (Wien). 1973;28:259–73. doi:10.1007/BF01405645.CrossRef Jorgensen EO. Spinal man after brain death. The unilateral extension-pronation reflex of the upper limb as an indication of brain death. Acta Neurochir (Wien). 1973;28:259–73. doi:10.​1007/​BF01405645.CrossRef
34.
Zurück zum Zitat Marti-Fabregas J, Lopez-Navidad A, Caballero F, Otermin P. Decerebrate-like posturing with mechanical ventilation in brain death. Neurology. 2000;54:224–7.PubMed Marti-Fabregas J, Lopez-Navidad A, Caballero F, Otermin P. Decerebrate-like posturing with mechanical ventilation in brain death. Neurology. 2000;54:224–7.PubMed
35.
Zurück zum Zitat Jordan JE, Dyess E, Cliett J. Unusual spontaneous movements in brain-dead patients. Neurology. 1985;35:1082.PubMed Jordan JE, Dyess E, Cliett J. Unusual spontaneous movements in brain-dead patients. Neurology. 1985;35:1082.PubMed
37.
Zurück zum Zitat Hirata K, Matsumoto Y, Kurokawa A, et al. Possibility of influence of midazolam sedation on the diagnosis of brain death: concentrations of active metabolites after cessation of midazolam. Yakugaku Zasshi. 2003;123:811–5. doi:10.1248/yakushi.123.811.PubMedCrossRef Hirata K, Matsumoto Y, Kurokawa A, et al. Possibility of influence of midazolam sedation on the diagnosis of brain death: concentrations of active metabolites after cessation of midazolam. Yakugaku Zasshi. 2003;123:811–5. doi:10.​1248/​yakushi.​123.​811.PubMedCrossRef
38.
Zurück zum Zitat Meinitzer A, Zink M, Marz W, Baumgartner A, Halwachs-Baumann G. Midazolam and its metabolites in brain death diagnosis. Int J Clin Pharmacol Ther. 2005;43:517–26.PubMed Meinitzer A, Zink M, Marz W, Baumgartner A, Halwachs-Baumann G. Midazolam and its metabolites in brain death diagnosis. Int J Clin Pharmacol Ther. 2005;43:517–26.PubMed
39.
Zurück zum Zitat Oldenhof H, de Jong M, Steenhoek A, Janknegt R. Clinical pharmacokinetics of midazolam in intensive care patients, a wide interpatient variability? Clin Pharmacol Ther. 1988;43:263–9.PubMed Oldenhof H, de Jong M, Steenhoek A, Janknegt R. Clinical pharmacokinetics of midazolam in intensive care patients, a wide interpatient variability? Clin Pharmacol Ther. 1988;43:263–9.PubMed
40.
Zurück zum Zitat Kennedy MC, Moran JL, Fearnside M, et al. Drugs and brain death. Med J Aust. 1996;165:394–8.PubMed Kennedy MC, Moran JL, Fearnside M, et al. Drugs and brain death. Med J Aust. 1996;165:394–8.PubMed
42.
Zurück zum Zitat Dobb GJ, Weekes JW. Clinical confirmation of brain death. Anaesth Intensive Care. 1995;23:37–43.PubMed Dobb GJ, Weekes JW. Clinical confirmation of brain death. Anaesth Intensive Care. 1995;23:37–43.PubMed
43.
Zurück zum Zitat Pallis C. ABC of brain stem death. Diagnosis of brain stem death—I. Br Med J (Clin Res Ed). 1982;285:1558–60.CrossRef Pallis C. ABC of brain stem death. Diagnosis of brain stem death—I. Br Med J (Clin Res Ed). 1982;285:1558–60.CrossRef
45.
Zurück zum Zitat Goudreau JL, Wijdicks EF, Emery SF. Complications during apnea testing in the determination of brain death: predisposing factors. Neurology. 2000;55:1045–8.PubMed Goudreau JL, Wijdicks EF, Emery SF. Complications during apnea testing in the determination of brain death: predisposing factors. Neurology. 2000;55:1045–8.PubMed
46.
Zurück zum Zitat Wu XL, Fang Q, Li L, Qiu YQ, Luo BY. Complications associated with the apnea test in the determination of the brain death. Chin Med J (Engl). 2008;121:1169–72. Wu XL, Fang Q, Li L, Qiu YQ, Luo BY. Complications associated with the apnea test in the determination of the brain death. Chin Med J (Engl). 2008;121:1169–72.
48.
Zurück zum Zitat Earnest MP, Beresford HR, McIntyre HB. Testing for apnea in suspected brain death: methods used by 129 clinicians. Neurology. 1986;36:542–4.PubMed Earnest MP, Beresford HR, McIntyre HB. Testing for apnea in suspected brain death: methods used by 129 clinicians. Neurology. 1986;36:542–4.PubMed
49.
Zurück zum Zitat Marks SJ, Zisfein J. Apneic oxygenation in apnea tests for brain death. A controlled trial. Arch Neurol. 1990;47:1066–8.PubMed Marks SJ, Zisfein J. Apneic oxygenation in apnea tests for brain death. A controlled trial. Arch Neurol. 1990;47:1066–8.PubMed
50.
Zurück zum Zitat Wijdicks EF. In search of a safe apnea test in brain death: is the procedure really more dangerous than we think? Arch Neurol. 1995;52:338–9.PubMed Wijdicks EF. In search of a safe apnea test in brain death: is the procedure really more dangerous than we think? Arch Neurol. 1995;52:338–9.PubMed
52.
Zurück zum Zitat Brandstetter RD, Choi MY, Mallepalli VN, Klass S. An unusual cause of pulmonary barotrauma during apneic oxygenation testing. Heart Lung. 1994;23:88–9.PubMed Brandstetter RD, Choi MY, Mallepalli VN, Klass S. An unusual cause of pulmonary barotrauma during apneic oxygenation testing. Heart Lung. 1994;23:88–9.PubMed
53.
Zurück zum Zitat Lessard M, Mallais R, Turmel A. Apnea test in the diagnosis of brain death. Can J Neurol Sci. 2000;27:353–4.PubMed Lessard M, Mallais R, Turmel A. Apnea test in the diagnosis of brain death. Can J Neurol Sci. 2000;27:353–4.PubMed
58.
Zurück zum Zitat Holzman BH, Curless RG, Sfakianakis GN, Ajmone-Marsan C, Montes JE. Radionuclide cerebral perfusion scintigraphy in determination of brain death in children. Neurology. 1983;33:1027–31.PubMed Holzman BH, Curless RG, Sfakianakis GN, Ajmone-Marsan C, Montes JE. Radionuclide cerebral perfusion scintigraphy in determination of brain death in children. Neurology. 1983;33:1027–31.PubMed
59.
Zurück zum Zitat Wijdicks EF. Determining brain death in adults. Neurology. 1995;45:1003–11.PubMed Wijdicks EF. Determining brain death in adults. Neurology. 1995;45:1003–11.PubMed
60.
62.
Zurück zum Zitat Yoshikai T, Tahara T, Kuroiwa T, et al. Plain CT findings of brain death confirmed by hollow skull sign in brain perfusion SPECT. Radiat Med. 1997;15:419–24.PubMed Yoshikai T, Tahara T, Kuroiwa T, et al. Plain CT findings of brain death confirmed by hollow skull sign in brain perfusion SPECT. Radiat Med. 1997;15:419–24.PubMed
63.
Zurück zum Zitat Dupas B, Gayet-Delacroix M, Villers D, Antonioli D, Veccherini MF, Soulillou JP. Diagnosis of brain death using two-phase spiral CT. AJNR Am J Neuroradiol. 1998;19:641–7.PubMed Dupas B, Gayet-Delacroix M, Villers D, Antonioli D, Veccherini MF, Soulillou JP. Diagnosis of brain death using two-phase spiral CT. AJNR Am J Neuroradiol. 1998;19:641–7.PubMed
66.
Zurück zum Zitat Ishii K, Onuma T, Kinoshita T, Shiina G, Kameyama M, Shimosegawa Y. Brain death: MR and MR angiography. AJNR Am J Neuroradiol. 1996;17:731–5.PubMed Ishii K, Onuma T, Kinoshita T, Shiina G, Kameyama M, Shimosegawa Y. Brain death: MR and MR angiography. AJNR Am J Neuroradiol. 1996;17:731–5.PubMed
70.
Zurück zum Zitat Reilly EL, Kelley JT, Pena YM. Failure of Pavulon to consistently provide adequate EMG attenuation for recording electrocerebral inactivity. Clin Electroencephalogr. 1985;16:72–6.PubMed Reilly EL, Kelley JT, Pena YM. Failure of Pavulon to consistently provide adequate EMG attenuation for recording electrocerebral inactivity. Clin Electroencephalogr. 1985;16:72–6.PubMed
71.
Zurück zum Zitat Grigg MM, Kelly MA, Celesia GG, Ghobrial MW, Ross ER. Electroencephalographic activity after brain death. Arch Neurol. 1987;44:948–54.PubMed Grigg MM, Kelly MA, Celesia GG, Ghobrial MW, Ross ER. Electroencephalographic activity after brain death. Arch Neurol. 1987;44:948–54.PubMed
73.
74.
Zurück zum Zitat Sonoo M, Tsai-Shozawa Y, Aoki M, et al. N18 in median somatosensory evoked potentials: a new indicator of medullary function useful for the diagnosis of brain death. J Neurol Neurosurg Psychiatry. 1999;67:374–8. doi:10.1136/jnnp.67.3.374.PubMedCrossRef Sonoo M, Tsai-Shozawa Y, Aoki M, et al. N18 in median somatosensory evoked potentials: a new indicator of medullary function useful for the diagnosis of brain death. J Neurol Neurosurg Psychiatry. 1999;67:374–8. doi:10.​1136/​jnnp.​67.​3.​374.PubMedCrossRef
75.
Zurück zum Zitat Wagner W. Scalp, earlobe and nasopharyngeal recordings of the median nerve somatosensory evoked P14 potential in coma and brain death. Detailed latency and amplitude analysis in 181 patients. Brain. 1996;119(Pt 5):1507–21. doi:10.1093/brain/119.5.1507.PubMedCrossRef Wagner W. Scalp, earlobe and nasopharyngeal recordings of the median nerve somatosensory evoked P14 potential in coma and brain death. Detailed latency and amplitude analysis in 181 patients. Brain. 1996;119(Pt 5):1507–21. doi:10.​1093/​brain/​119.​5.​1507.PubMedCrossRef
76.
Zurück zum Zitat Mauguiere F, Ibanez V. The dissociation of early SEP components in lesions of the cervico-medullary junction: a cue for routine interpretation of abnormal cervical responses to median nerve stimulation. Electroencephalogr Clin Neurophysiol. 1985;62:406–20. doi:10.1016/0168-5597(85)90050-4.PubMedCrossRef Mauguiere F, Ibanez V. The dissociation of early SEP components in lesions of the cervico-medullary junction: a cue for routine interpretation of abnormal cervical responses to median nerve stimulation. Electroencephalogr Clin Neurophysiol. 1985;62:406–20. doi:10.​1016/​0168-5597(85)90050-4.PubMedCrossRef
77.
Zurück zum Zitat Roncucci P, Lepori P, Mok MS, Bayat A, Logi F, Marino A. Nasopharyngeal electrode recording of somatosensory evoked potentials as an indicator in brain death. Anaesth Intensive Care. 1999;27:20–5.PubMed Roncucci P, Lepori P, Mok MS, Bayat A, Logi F, Marino A. Nasopharyngeal electrode recording of somatosensory evoked potentials as an indicator in brain death. Anaesth Intensive Care. 1999;27:20–5.PubMed
78.
Zurück zum Zitat Bhattarai BK. An analysis of brainstem auditory evoked potentials (BAEP) in brain death and its usefulness in the diagnosis of brain death. J Anaesth Clin Pharmacol. 2002;18:397–404. Bhattarai BK. An analysis of brainstem auditory evoked potentials (BAEP) in brain death and its usefulness in the diagnosis of brain death. J Anaesth Clin Pharmacol. 2002;18:397–404.
80.
Zurück zum Zitat Goldie WD, Chiappa KH, Young RR, Brooks EB. Brainstem auditory and short-latency somatosensory evoked responses in brain death. Neurology. 1981;31:248–56.PubMed Goldie WD, Chiappa KH, Young RR, Brooks EB. Brainstem auditory and short-latency somatosensory evoked responses in brain death. Neurology. 1981;31:248–56.PubMed
83.
Zurück zum Zitat Kurtek RW, Lai KK, Tauxe WN, Eidelman BH, Fung JJ. Tc-99m hexamethylpropylene amine oxime scintigraphy in the diagnosis of brain death and its implications for the harvesting of organs used for transplantation. Clin Nucl Med. 2000;25:7–10. doi:10.1097/00003072-200001000-00002.PubMedCrossRef Kurtek RW, Lai KK, Tauxe WN, Eidelman BH, Fung JJ. Tc-99m hexamethylpropylene amine oxime scintigraphy in the diagnosis of brain death and its implications for the harvesting of organs used for transplantation. Clin Nucl Med. 2000;25:7–10. doi:10.​1097/​00003072-200001000-00002.PubMedCrossRef
85.
Zurück zum Zitat Harding JW, Chatterton BE. Outcomes of patients referred for confirmation of brain death by 99mTc-exametazime scintigraphy. Intensive Care Med. 2003;29:539–43.PubMed Harding JW, Chatterton BE. Outcomes of patients referred for confirmation of brain death by 99mTc-exametazime scintigraphy. Intensive Care Med. 2003;29:539–43.PubMed
86.
Zurück zum Zitat Kraft O, Samlik J, Chmelova J. The diagnosis of brain death—own experience. Nucl Med Rev Cent East Eur. 2006;9:132–7.PubMed Kraft O, Samlik J, Chmelova J. The diagnosis of brain death—own experience. Nucl Med Rev Cent East Eur. 2006;9:132–7.PubMed
88.
Zurück zum Zitat Ducrocq X, Hassler W, Moritake K, et al. Consensus opinion on diagnosis of cerebral circulatory arrest using Doppler-sonography: Task Force Group on cerebral death of the Neurosonology Research Group of the World Federation of Neurology. J Neurol Sci. 1998;159:145–50. doi:10.1016/S0022-510X(98)00158-0.PubMedCrossRef Ducrocq X, Hassler W, Moritake K, et al. Consensus opinion on diagnosis of cerebral circulatory arrest using Doppler-sonography: Task Force Group on cerebral death of the Neurosonology Research Group of the World Federation of Neurology. J Neurol Sci. 1998;159:145–50. doi:10.​1016/​S0022-510X(98)00158-0.PubMedCrossRef
89.
Zurück zum Zitat Sloan MA, Alexandrov AV, Tegeler CH, et al. Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2004;62:1468–81.PubMed Sloan MA, Alexandrov AV, Tegeler CH, et al. Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2004;62:1468–81.PubMed
93.
95.
Zurück zum Zitat Ropper AH, Kehne SM, Wechsler L. Transcranial Doppler in brain death. Neurology. 1987;37:1733–5.PubMed Ropper AH, Kehne SM, Wechsler L. Transcranial Doppler in brain death. Neurology. 1987;37:1733–5.PubMed
98.
Zurück zum Zitat Petty GW, Mohr JP, Pedley TA, et al. The role of transcranial Doppler in confirming brain death: sensitivity, specificity, and suggestions for performance and interpretation. Neurology. 1990;40:300–3.PubMed Petty GW, Mohr JP, Pedley TA, et al. The role of transcranial Doppler in confirming brain death: sensitivity, specificity, and suggestions for performance and interpretation. Neurology. 1990;40:300–3.PubMed
99.
Zurück zum Zitat van der Naalt J, Baker AJ. Influence of the intra-aortic balloon pump on the transcranial Doppler flow pattern in a brain-dead patient. Stroke. 1996;27:140–2.PubMed van der Naalt J, Baker AJ. Influence of the intra-aortic balloon pump on the transcranial Doppler flow pattern in a brain-dead patient. Stroke. 1996;27:140–2.PubMed
100.
Zurück zum Zitat Lopez-Navidad A, Caballero F, Domingo P, et al. Early diagnosis of brain death in patients treated with central nervous system depressant drugs. Transplantation. 2000;70:131–5.PubMed Lopez-Navidad A, Caballero F, Domingo P, et al. Early diagnosis of brain death in patients treated with central nervous system depressant drugs. Transplantation. 2000;70:131–5.PubMed
103.
Zurück zum Zitat Diaz-Reganon G, Minambres E, Holanda M, Gonzalez-Herrera S, Lopez-Espadas F, Garrido-Diaz C. Usefulness of venous oxygen saturation in the jugular bulb for the diagnosis of brain death: report of 118 patients. Intensive Care Med. 2002;28:1724–8. doi:10.1007/s00134-002-1543-8.PubMedCrossRef Diaz-Reganon G, Minambres E, Holanda M, Gonzalez-Herrera S, Lopez-Espadas F, Garrido-Diaz C. Usefulness of venous oxygen saturation in the jugular bulb for the diagnosis of brain death: report of 118 patients. Intensive Care Med. 2002;28:1724–8. doi:10.​1007/​s00134-002-1543-8.PubMedCrossRef
104.
Zurück zum Zitat Kytta J, Ohman J, Tanskanen P, Randell T. Extracranial contribution to cerebral oximetry in brain dead patients: a report of six cases. J Neurosurg Anesthesiol. 1999;11:252–4.PubMedCrossRef Kytta J, Ohman J, Tanskanen P, Randell T. Extracranial contribution to cerebral oximetry in brain dead patients: a report of six cases. J Neurosurg Anesthesiol. 1999;11:252–4.PubMedCrossRef
105.
Zurück zum Zitat Watanabe T, Honda Y, Fujii Y, Koyama M, Tanaka R. Serial evaluation of axonal function in patients with brain death by using anisotropic diffusion-weighted magnetic resonance imaging. J Neurosurg. 2004;100:56–60.PubMedCrossRef Watanabe T, Honda Y, Fujii Y, Koyama M, Tanaka R. Serial evaluation of axonal function in patients with brain death by using anisotropic diffusion-weighted magnetic resonance imaging. J Neurosurg. 2004;100:56–60.PubMedCrossRef
108.
Zurück zum Zitat Dunham CM, Ransom KJ, McAuley CE, Gruber BS, Mangalat D, Flowers LL. Severe brain injury ICU outcomes are associated with Cranial-Arterial Pressure Index and noninvasive Bispectral Index and transcranial oxygen saturation: a prospective, preliminary study. Crit Care. 2006;10:R159. doi:10.1186/cc5097.PubMedCrossRef Dunham CM, Ransom KJ, McAuley CE, Gruber BS, Mangalat D, Flowers LL. Severe brain injury ICU outcomes are associated with Cranial-Arterial Pressure Index and noninvasive Bispectral Index and transcranial oxygen saturation: a prospective, preliminary study. Crit Care. 2006;10:R159. doi:10.​1186/​cc5097.PubMedCrossRef
109.
110.
Zurück zum Zitat Ingebrigtsen T, Romner B, Kongstad P, Langbakk B. Increased serum concentrations of protein S-100 after minor head injury: a biochemical serum marker with prognostic value? J Neurol Neurosurg Psychiatry. 1995;59:103–4. doi:10.1136/jnnp.59.1.103-a.PubMedCrossRef Ingebrigtsen T, Romner B, Kongstad P, Langbakk B. Increased serum concentrations of protein S-100 after minor head injury: a biochemical serum marker with prognostic value? J Neurol Neurosurg Psychiatry. 1995;59:103–4. doi:10.​1136/​jnnp.​59.​1.​103-a.PubMedCrossRef
116.
117.
Zurück zum Zitat Flowers WM Jr, Patel BR. Accuracy of clinical evaluation in the determination of brain death. South Med J. 2000;93:203–6.PubMed Flowers WM Jr, Patel BR. Accuracy of clinical evaluation in the determination of brain death. South Med J. 2000;93:203–6.PubMed
Metadaten
Titel
Pitfalls in the Diagnosis of Brain Death
verfasst von
Katharina M. Busl
David M. Greer
Publikationsdatum
01.10.2009
Verlag
Humana Press Inc
Erschienen in
Neurocritical Care / Ausgabe 2/2009
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-009-9231-y

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