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Brain Stem Death

  • Argyro Zoumprouli
  • Konstantina Ilia Karydi
Chapter

Abstract

Death causes the irreversible loss of those essential characteristics which are necessary to the existence of a living human being. In many countries, the neurological criteria include the irreversible cessation of the function of the whole brain. In contrast, there are also countries that align the concept of brain death with that of brainstem death.

Although the clinical examination, who is performing it, how and when are varying in each country, there are universal principles that should be followed to reach a correct diagnosis.

The clinicians involved should be senior and competent, and the tests should be repeated twice by two different clinicians, who should not be members of the organ procurement or transplant teams.

The patient should be in coma and apnea. The underlying cause of the coma should be known, and a clear diagnosis of the irreversible brain damage before brain stem testing is paramount.

Once confounding conditions and reversible causes that may impair consciousness, brain stem activity and neuromuscular transmission have been excluded, the absence of brain stem reflexes confirms brain death. In case of neuromuscular disorders, high-level cervical spinal injuries and inability to test reliably all brain stem reflexes, ancillary testing should always be performed.

Keywords

Apnea Brainstem Brain death Cerebral angiography Electroencephalography Radionuclide imaging Somatosensory evoked potentials Transcranial Doppler ultrasonography 

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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Argyro Zoumprouli
    • 1
  • Konstantina Ilia Karydi
    • 2
  1. 1.Department of Anaesthesia and Intensive CareSt. George’s University Hospitals NHS Foundation TrustLondonUK
  2. 2.Neuro Intensive Care UnitSt. George’s University Hospitals NHS Foundation TrustLondonUK

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