Brief observationSpontaneous and reflex movements in 107 patients with brain death
Section snippets
Methods
We conducted a multicenter cohort study of patients with brain death admitted to the hospital care system of Buenos Aires from July 1997 to March 2003. All patients fulfilled standard criteria for brain death,2 including unresponsiveness or coma, absence of brainstem reflexes, and apnea. Whenever intensive care physicians made this diagnosis, the organ procurement team was called and brain death was confirmed by a trained and experienced neurologist. All patients had a second evaluation at the
Results
Among 107 patients with a confirmed diagnosis of brain death, 47 (44%) had spontaneous or reflex movements. The most common movements were the undulating toe reflex and the triple flexion response (Table 1). Twelve patients (26%) had more than one type of movement.
There were no statistically significant differences in age, sex, baseline temperature, blood pH, bicarbonate and partial pressure of carbon dioxide levels, and cause of death between patients with and without movements (Table 2).
Discussion
Anecdotal reports and retrospective case series have described involuntary, spontaneous, or reflex movements in as many as 75% of patients with brain death.6, 7, 11, 12, 13 However, many of these studies were performed before the current criteria for brain death were established. For example, one study8 used loss of the cough reflex to determine the time of brain death. In our study, we evaluated more than 100 patients over a 5-year period using a standardized protocol and found that almost
Acknowledgment
We are indebted to patients’ relatives who agreed with the video recording. We also appreciate the kind support of Dr. Jorge Deluca, the team of “Buenos Aires Transplant”, and emergency and intensive care physicians from the Community and University Hospitals of the City of Buenos Aires. We are also grateful to Drs. Fernando Rubinstein and Ezequiel García Elorrio, and members from the Clinical Effectiveness Program (PEC) at the University of Buenos Aires, for their collaboration with the study
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Spontaneous and reflex movements after diagnosis of clinical brain death: A lesson from acute encephalopathy
2022, Brain and DevelopmentCitation Excerpt :Although a detailed analysis of body movements in the brain-dead state has been performed [5,6], it is not easy to determine the origin of the various movements that our patient exhibited. The flexion or flexor reflex recorded in the lower limbs, in both animals and humans, is mediated by a complex circuitry modulated at the spinal and supraspinal levels, including the brainstem [7]. Hence, it is difficult to determine whether the patient's movements originated purely in the spinal cord or at least partly in the brainstem.
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Brain Death
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