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Neurocritical Care

, Volume 27, Issue 3, pp 407–414 | Cite as

Primary Posterior Fossa Lesions and Preserved Supratentorial Cerebral Blood Flow: Implications for Brain Death Determination

  • Panayiotis N. VarelasEmail author
  • Paul Brady
  • Mohammed Rehman
  • Arash Afshinnik
  • Chandan Mehta
  • Tamer Abdelhak
  • Eelco F. Wijdicks
Original Article

Abstract

Background

Patients with primary posterior fossa catastrophic lesions may clinically meet brain death criteria, but may retain supratentorial brain function or blood flow. These patients could be declared brain-dead in the United Kingdom (UK), but not in the United States of America (USA). We report the outcome of adult patients with primary posterior fossa lesions without concurrent major supratentorial injury.

Methods

Henry Ford Hospital database was reviewed over a period of 88 months in order to identify all adult patients with isolated brainstem or posterior fossa lesions. We excluded patients with concurrent significant supratentorial pathology potentially confounding the clinical brain death examination. One more patient from a different hospital meeting these criteria was also included.

Results

Three patients out of 161 met inclusion criteria (1.9% of all brain deaths during this period). With the addition of a fourth patient from another hospital, 4 patients were analyzed. All four patients had catastrophic brainstem and cerebellar injuries meeting the clinical criteria of brain death with positive apnea test in the UK. All had preserved supratentorial blood flow, which after a period of 2 h to 6 days disappeared on repeat testing, allowing declaration of brain death by US criteria in all four. One patient became an organ donor.

Conclusions

Patients with primary posterior fossa catastrophic lesions, who clinically seem to be brain-dead, evolve from retaining to losing supratentorial blood flow. If absent cerebral blood flow is used as an additional criterion for the declaration of death by neurological criteria, these patients are not different than those who become brain death due to supratentorial lesions.

Keywords

Cerebrovascular disease/Stroke Brain death Brainstem death Apnea test Blood flow 

Notes

Author Contributions

PV: study concept, data acquisition, analysis or interpretation of the data interpretation of data, drafting and revising the manuscript. PB: data acquisition, analysis or interpretation of the data interpretation of data, drafting and revising the manuscript. MR: data acquisition, analysis or interpretation of the data interpretation of data, drafting and revising the manuscript. AA: data acquisition, analysis or interpretation of the data interpretation of data, drafting and revising the manuscript. CM: data acquisition, critical interpretation of data. TA: data acquisition, analysis or interpretation of the data interpretation of data, drafting and revising the manuscript. EF.W: study concept, data acquisition, analysis or interpretation of the data interpretation of data, drafting and revising the manuscript.

Compliance with Ethical Standards

Conflict of interest

Panayiotis Varelas has received honoraria from serving on the scientific advisory board of Lunbeck, Portola and UCB. Speaker’s honoraria from Bard and UCB. He receives book royalties from Springer. He has served on the Advisory Board of Gift of Life of Michigan. Paul Brady reports no disclosures. Mohammed Rehman is serving on the Advisory Board of Gift of Life of Michigan. Arash Afshinnik reports no disclosures. Chandan Mehta reports no disclosures. Tamer Abdelhak has received speaker’s honoraria from CSL Behring. Eelco F.Wijdicks has received royalties for books published by Oxford university press and royalties for articles written for up to date.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Departments of Neurology, Neurosciences Critical Care UnitsHenry Ford HospitalDetroitUSA
  2. 2.Departments of Neurology, Neurosciences Critical Care UnitsCommunity Regional Medical Center HospitalFresnoUSA
  3. 3.Departments of Neurology, Neurosciences Critical Care UnitsMayo ClinicRochesterUSA
  4. 4.NeuroCritical Care ServiceHenry Ford HospitalDetroitUSA
  5. 5.Wayne State University School of MedicineDetroitUSA

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