Sixty-three patients who fulfilled neurological, electroencephalographic and angiographic criteria of brain death were investigated longitudinally.
Spinal man during the first 200 hours after brain death is described. Most patients had bilateral mydriasis but unilateral mydriasis or bilateral non mydriatic pupils were also encountered. Poikilothermia was found in all patients later than 24 hours after brain death. Half the patients had diabetes insipidus.
Fifty patients retained or regained spinal reflex activity after brain death. Any of the ordinary deep and superficial reflexes except the plantar reflex could be present; however, if spinal reflexes were present, the flexion-withdrawal reflex was invariably there. The skin area from which the flexion reflex was elicited was congruent to the 3rd and 4th lumbar sensory dermatomes. Moreover, unilateral extension-pronation movements of the upper limb elicited from distinct skin fields congruent to the 8th cervical and all the thoracic sensory dermatomes emerged later than 6 hours after brain death. This reflex is a simple indicator of brain death of any aetiology.
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Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. J. Amer. Med. Ass.205 (1968), 337–340.
Arfel, G., Problèmes électroencéphalographiques de la mort. Paris: Masson. 1970.
Becker, D. P., C. M. Robert, J. R. Nelson, and W. E. Stern, An evaluation of the definition of cerebral death. Neurology20 (1970), 459–462.
Chusid, J. G., and J. J. McDonald, Correlative neuroanatomy and functional neurology. Los Altos: Lange. 1967.
Feldman, M. H., and S. Sahrmann, The decerebrate state in the primate. Arch. Neurol.25 (1971), 517–525.
Foerster, O., The dermatomes in man. Brain56 (1933), 1–39.
Fulton, J. F., and G. P. McCouch, The relation of the motor area of primates to the hyporeflexia (“spinal shock”) of spinal transection. J. Nerv. Ment. Dis.86 (1937), 125–146.
Hagbarth, K.-E., Excitatory and inhibitory skin areas for flexor and extensor motoneurones. Acta Physiol. Scand.26 (1952), suppl. 94.
Jørgensen, E. O., and P. Brodersen, Criteria of death. Nord. Med.86 (1971), 1549–1560.
- Hemodynamic changes following aortocervical, internal carotid and vertebral angiography in suspected brain death. Acta Radiol. (Stockh.), in press.
- EEG without detectable cortical activity and cranial nerve areflexia as parameters of brain death. Electroencephaloclin. Neurophysiol., in press.
Kuhn, R. A., and M. B. Macht, Some manifestations of reflex activity in spinal man with particular reference to the occurrence of extensor spasms. Bull. Johns Hopkins Hosp.84 (1949), 43–75.
Langworthy, O. R., The mechanism of the abdominal and cremasteric reflexes. Arch. Neurol. Psychiat.24 (1930), 1023–1033.
Lindgren, P., and G. Törnell, Blood pressure and heart rate responses in carotid angiography with sodium acetrizoate (triurol). Acta Radiol. (Stockh.)50 (1958), 160–174.
Lønnum, A., The abdominal skin reflexes in man: An analysis of the reflex findings in early infancy and in patients with cerebral disease. Acta Psychiat. Neurol. Scand. (1957), suppl. 108.
Mollaret, P., and M. Goulon, Le coma depassé. Rev. Neurol.101 (1959), 3–15.
Monrad-Krohn, G. H., Reflexes of different order elicitable from the abdominal region. Arch. Neurol. Psychiat.66 (1950), 338–345.
Penin, H., and C. H. Käufer (eds.), Der Hirntod. Stuttgart: Thieme. 1969.
Schneider, H., W. Masshoff, and G. A. Neuhaus, Klinische und morphologische Aspekte des Hirntodes. Klin. Wschr.16 (1969), 844–859.
Schwartz, B. A., and E. Vendrely, Un des problèmes posés par le diagnostic du coma depassé: EEG nul et diametre pupillaire. Rev. Neurol.121 (1969), 319–323.
Sherrington, G. S., Experiments in the examination of the peripheral distribution of the fibres of the posterior roots of some spinal nerves. Philos. Tr. Roy. Soc.190 (1898), 45–186.
—, Flexion reflex of the limb, crossed extensor reflex and reflex stepping and standing. J. Physiol.40 (1910), 28–121.
Silver, J. R., Vascular reflexes in spinal shock. Paraplegia8 (1970), 231–242.
Tönnis, W., and R. A. Frowein, Wie lange ist Wiederbelebung bei schweren Hirnverletzungen möglich? Mschr. Unfallheilk.66 (1963), 169–190.
Supported by the P. Carl Petersen Foundation and the Danish Heart Foundation.
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Jørgensen, E.O. Spinal man after brain death. Acta neurochir 28, 259–273 (1973). https://doi.org/10.1007/BF01405645
- Public Health
- Interventional Radiology
- Brain Death
- Diabetes Insipidus
- Skin Area