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Spinal man after brain death

The unilateral extension-pronation reflex of the upper limb as an indication of brain death

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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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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).

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