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Brain death-associated reflexes and automatisms

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Abstract

Background: In several instances, the diagnosis of brain death has been questioned due to the presence of movements. This case report and review of the literature illustrates the spectrum of movements that have been encountered in brain death.

Methods: A case report and review of the literature on movements seen in brain death was conducted.

Results: Movements in brain death are common and have a wide range of phenomenology. Several movements wax and wane over time, making movements in brain death difficult to classify. In addition, varying terminology has been used (e.g., Lazarus sign, spinal man, spinal reflexes, spinal automatisms). Although evidence points to a spinal origin for such movements, the pathophysiology in many cases remains speculative. Characteristics of movements in brain death have been identified that can help differentiate them from brainstem or voluntary origin.

Conclusions: Based on our review, we suggest referring to stimulus-provoked movements as reflexes and spontaneous movements as automatisms. We propose using the terms brain death-associated reflexes and brain death-associated automatisms as two main categories for movements that occur in brain death. These terms do not imply a specific pathophysiology, but consistent clinically oriented nomenclature may be useful when reporting such phenomena.

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References

  1. Saposnik G, Maruino J, Bueri JA. Movements in brain death. Eur J Neurol 2001;8:209–213.

    Article  PubMed  CAS  Google Scholar 

  2. Wijdicks EFM. The diagnosis of brain death. N Engl J Med 2001;344:1215–1221.

    Article  PubMed  CAS  Google Scholar 

  3. Plum F, Posner J. The diagnosis of stupor and coma, 3rd ed. Philadelphia: F.A. Davis Company, 1982.

    Google Scholar 

  4. Jorgensen EO. Spinal man after brain death. Acta Neurochir (Wien) 1973;28:259–273.

    Article  CAS  Google Scholar 

  5. Spittler JF, Wortmann D, von During M, Gehlen, W. Phenomenological diversity of spinal reflexes in brain death. Eur J Neurol 2000;7:315–321.

    Article  PubMed  CAS  Google Scholar 

  6. Ivan L. Spinal reflexes in cerebral death. Neurology 1973;23:650–652.

    PubMed  CAS  Google Scholar 

  7. Dösemeci L, Cengiz M, Yilmaz M, Ramazanoglu A. Frequency of spinal reflex movements in brain-dead patients. Transplant Proc 2004;36:17–19.

    Article  PubMed  Google Scholar 

  8. Saposnik G, Maurinoj, Saizar R, Bueri JA. Undulating toe movements in brain death. Eur J Neurol 2004;11:723–727.

    Article  PubMed  CAS  Google Scholar 

  9. Conci F, Procaccio F, Arosio M, Boselli L. Viscero-somatic and viscero-visceral reflexes in brain death. J Neurol Neurosurg Psychiatry 1986;49:695–698.

    PubMed  CAS  Google Scholar 

  10. de Freitas GR, Lima MASD, Andre C. Complex spinal reflexes during transcranial Doppler ultrasound examination for the confirmation of brain death. Acta Neurol Scand 2003;108:170–173.

    Article  PubMed  Google Scholar 

  11. Urasaki E, Tokimura T, Kumai J, Wada S, Yokota A. Preserved spinal dorsal horn potentials in a brain-dead patient with Lazarus’ sign. J Neurosurg 1992;76:710–713.

    PubMed  CAS  Google Scholar 

  12. Turmel A, Roux A, Bojanowski MW. Spinal man after declaration of brain death. Neurosurgery 1991;28:298–301.

    Article  PubMed  CAS  Google Scholar 

  13. Jastremski M, Powner D, Snyder J, Smith J, Grenvik A. Sponteneous decerebrate movement after declaration of brain death. Neurosurgery 1991;3:479–480.

    Article  Google Scholar 

  14. Heytens L, Verlooy J, Gheuens J, Bossaert L. Lazarus sign and extensor posturing in a brain-dead patient. J Neurosurg 1989;71:449–451.

    Article  PubMed  CAS  Google Scholar 

  15. Ropper A. Unusual spontaneous movements in brain-dead patients. Neurology 1984;34:1089–1092.

    PubMed  CAS  Google Scholar 

  16. Hanna J, Frank J. Automatic stepping in the pontomedullary stage of central herniation. Neurology 1995;45:985–986.

    PubMed  CAS  Google Scholar 

  17. American Academy of Neurology. Practice parameters: determining brain death in adults. www.aan.com (accessed April 2004).

  18. Rodrigues W, Vyas H. Movements in brain death. Eur J Neurol 2002;9:687–702.

    Article  PubMed  CAS  Google Scholar 

  19. Fujimoto K, Yamauchi Y, Yoshida M. Spinal myoclonus in association with brain death. Rinsho Shinkeigaku 1989;11:1417–1419.

    Google Scholar 

  20. Aranibar RJ. Spinal man after declaration of brain death. Neurosurgery 1991;28:933.

    Article  PubMed  CAS  Google Scholar 

  21. Friedman A. Sympathetic response and brain death. Arch Neurol 1984;41:15.

    PubMed  CAS  Google Scholar 

  22. Christie J, O’Lenic T, Cane R. Head turning in brain death. J Clini Anesth 1996;8:141–143.

    Article  CAS  Google Scholar 

  23. Marti-Fabregas J, Lopez-Navidad A, Caballero F, Otermin P. Decerebrate-like posturing with mechanical ventilation in brain death. Neurology 2000;54:224–227.

    PubMed  CAS  Google Scholar 

  24. McNair NL, Meador KJ. The undulating toe flexion sign in brain death. Mov Disord 1992;7:345–347.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Movement Disorders, Neurological Institute, 710 W. 168th St., 3rd Floor, 10032, New York, NY

    Samay Jain

  2. Department of Neurology and Neurosurgery, The Cleveland Clinic Foundation, Cleveland, OH

    Michael DeGeorgia

Authors
  1. Samay Jain
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  2. Michael DeGeorgia
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Correspondence to Samay Jain.

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Jain, S., DeGeorgia, M. Brain death-associated reflexes and automatisms. Neurocrit Care 3, 122–126 (2005). https://doi.org/10.1385/NCC:3:2:122

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