AI Article Synopsis

  • * Abnormal reflexive movements, particularly in the upper extremities, can complicate brain death diagnoses by misleadingly suggesting some retained brain function.
  • * A case study is presented involving a brain-dead patient who exhibited unexpected finger flexion in response to stimuli, raising questions about the underlying mechanisms, akin to those seen in upper motor neuron injuries.

Article Abstract

Several guidelines and definitions for brain death have been proposed. The Uniform Determination of Death Act (UDDA) in 1980, the American Academy of Neurology (AAN) guidelines in 1995 and the later update in 2010 have all described standards for diagnosing brain death. As brain death testing became more commonly performed, several abnormal reflexive movements were recognized and led to ambiguities that falsely suggested retained brain function. Movements in the upper extremities have been under-recognized. We report a brain-dead patient with finger flexion in the upper extremities with noxious stimulation and suspect a pathogenesis similar to that of Hoffman's reflex sign. We present a case of an asthmatic patient who presented with pulseless electrical activity (PEA). The patient was managed emergently and subsequently deteriorated to a comatose state. She remained in a comatose state following management and showed diffuse cerebral edema secondary to anoxic brain injury on computed tomography (CT) scan. Subsequent apnea testing, transcranial Doppler studies (TCD) and detailed neurological examinations were performed. She was eventually declared brain dead. On nailbed pressure to her fourth finger, she had flexion of her third finger, similar to the finding of a Hoffman's sign in an upper motor neuron injury. We have described this case in detail and reviewed the literature on abnormal movements in brain-dead patients.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344064PMC
http://dx.doi.org/10.7759/cureus.3622DOI Listing

Publication Analysis

Top Keywords

finger flexion
12
brain death
12
noxious stimulation
8
brain-dead patient
8
upper extremities
8
brain
6
finger
4
flexion noxious
4
stimulation brain-dead
4
patient case
4

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!