neurologic disorders
Brain Death
Diagnosis of Brain Death
Serial determination of clinical criteria Apnea testing Sometimes electroencephalography (EEG), brain vascular imaging, or both For a physician to declare brain death, a known structural or metabolic cause of brain damage must be present, and use of potentially anesthetizing or paralyzing drugs, especially self-administered, must be excluded. C must be increased slowly to > 36° C, and if status epilepticus is suspected, EEG should be done. In adults, after all complicating medical conditions have been excluded and a comprehensive neurologic examination with the required testing has been done, brain death can be confirmed. Some states advise clinicians to do two separate examinations separated by at least 48 hours in children; this approach is not consistently recommended or required for adult patients (see table Guidelines for Determining Brain Death (in Patients > 1 Year*)† ). Examination includes Assessment of pupil reactivity Assessment of oculovestibular, oculocephalic, and corneal reflexes Apnea testing Sometimes EEG or tests of brain perfusion are used to confirm absence of brain activity or brain blood flow and thus provide additional evidence to family members, but these tests are not usually required. They are indicated when apnea testing is not hemodynamically tolerated and when only one neurologic examination is desirable (eg, to expedite organ procurement for transplantation). 