{'fraction_non_alphanumeric': 0.023007395234182416, 'fraction_numerical': 0.011503697617091208, 'mean_word_length': 4.884057971014493, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Complex spinal reflexes in brain death

We appreciate the interest of Dr Lang regarding our article (1). Dr Lang points out that the spinal reflexes described in our study are not uncommon. Furthermore, he suggests that the title wrongly insinuates that transcranial Doppler ultrasound (TCD) may induce complex spinal movements. The movements described in only four (2.5%) of 161 patients in brain death (BD) in our study are not similar to the unilateral extension-pronation reflex of the upper limb. The latter was observed in 21 of 63 patients in the series of Jorgensen and was characterized by unilateral downward medial rotation of the shoulder with extension and pronation of the arm or forearm in response to ipsilateral cutaneous stimulation (2). Moreover, in a recent prospective study of reflexes including 38 patients in BD, only one presented the Lazarus sign and one the upper limb extension-pronation reflex (3). In the abstract and in the text it is clearly stated that movements were elicited by neck flexion. When mentioning transcranial Doppler ultrasound in the title, our aim was to draw the attention of intensive care personnel and neurologists who perform TCD to these complex movements in BD.