Brain death

Posted by e-Medical PPT Tuesday, June 22, 2010
A brain-dead person has no clinical evidence of brain function upon physical examination. This includes no response to pain and no cranial nerve reflexes. Reflexes include pupillary response (FIXED DILATED PUPILS), oculocephalic reflex, corneal reflex, no response to the caloric reflex test and no spontaneous respirations.
It is important to distinguish between brain death and states that may mimic brain death (e.g., barbiturate overdose, alcohol intoxication, sedative overdose, hypothermia, hypoglycemia, coma or chronic vegetative states). Some comatose patients can recover, and some patients with severe irreversible neurological dysfunction will nonetheless retain some lower brain functions such as spontaneous respiration, despite the losses of both cortex and brainstem functionality. Thus, anencephaly, in which there is no higher brain present, is generally not considered brain death, though it is certainly an irreversible condition in which it may be appropriate to withdraw life support.
The diagnosis of brain death needs to be rigorous, in order to be certain that the condition is irreversible. Legal criteria vary, but in general in the USA they require neurological examinations by two independent physicians. The exams must show complete absence of brain function, and may include two isoelectric (flat-line) EEGs 24 hours apart. 

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