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Brain Death and Organ Donation
Published in T.M. Craft, P.M. Upton, Key Topics In Anaesthesia, 2021
Brain stem death is defined as the irreversible cessation of brain stem function, but not necessarily the physical destruction of the brain. In the UK, it has been agreed that brain stem death = death (i.e. despite the presence of a beating heart). Prior to the diagnosis of brain stem death it is necessary to consider certain preconditions and exclusions. Head injury and intracranial haemorrhage account for approximately 80% of cases.
Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The Academy of Medical Royal Colleges published a 42-page document in 2008 titled ‘A Code of Practice for the Diagnosis and Confirmation of Death’. This document details the specific conditions necessary for the diagnosis and confirmation of brain stem death. In summary:
Critical Care and Anaesthesia
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rajkumar Rajendram, Alex Joseph, John Davidson, Avinash Gobindram, Prit Anand Singh, Animesh JK Patel
What is unresponsive wakefulness syndrome (UWS)? Does it constitute brain-stem death?There is no evidence of higher brain function but brain-stem reflexes are intact. This condition is also known as a persistent vegetative state (PVS) or apallic syndrome.There is much controversy about its definition and prognosis.There are reports of UWS being at least partially reversible.Some functional brain studies have shown that some patients with UWS have higher brain activity as a result of somatic stimuli despite no outward clinical evidence of this.It is not equivalent to brain-stem death.
Saved by the Pupillometer! – A role for pupillometry in the acute assessment of patients with traumatic brain injuries?
Published in Brain Injury, 2018
John A. Emelifeonwu, Kirsten Reid, Jonathan KJ Rhodes, Lynn Myles
In the acute phases of TBIs, elevations in ICP can result in inter-compartmental herniation of brain. If the area of neuronal injury is supratentorial, then this can lead to herniation of the medial temporal lobe and uncus through the tentorial incisura – the anterior opening between the free edge of the tentorium cerebelli and the clivus, which permits passage of the brainstem. Thus, the brainstem can become compromised. The anatomical proximity of the third cranial nerve to the medial temporal lobe renders it susceptible to compromise also (Figure 1), and the superficially located parasympathetic fibres, which constrict the pupils, are particularly vulnerable. Herniation of the temporal uncus through the incisura therefore compresses the third nerve and the parasympathetic fibres. It is this anatomy of the third nerve that is exploited by clinicians when assessing pupillary response in the context of TBIs; pupillary dilatation and/or non-reactivity suggest third nerve compromise and should prompt appropriate rescue therapeutic measures. The third nerve nucleus in the midbrain can also be affected in cases of brain stem death.
Surviving Brain Damage After Assault: From Vegetative State to Meaningful Life
Published in Brain Injury, 2018
There are 14 chapters, the first three of which begin by giving a useful overview of brain injury – looking at lobes and other brain structures, moving on in Chapter 2 to describe and define disorders of consciousness with various useful distinctions between the varying states, such as vegetative state, minimally conscious, coma, locked-in syndrome and brainstem death. These two chapters look at a range of the literature and usefully direct the reader to further reading on various different aspects. Chapter 3 considers imaging options available in brain injury and critically appraises its use in the planning and rehabilitation of brain injury patients.
Transcranial doppler ultrasonography cerebral blood flow dynamics study of neurosurgical patients in peri-agonal period with fixed dilated or non-reacting pupils
Published in British Journal of Neurosurgery, 2018
Pratyush Shrestha, Safiur Rahman Ansari, Ram Kumar Ghimire, Dinesh Nath Gongal, Upendra Psd Devkota
A total of 104 TCD studies were done during the study period out of which 25 times the TCD findings were suggestive of brain stem death. In this study, cessation of cardio-pulmonary activity was regarded as confirmatory death. Clinical criteria for brain stem death and other ancillary tests for confirmation of brain stem death were not done.