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The diagnosis of brain depression in the presence of severe multisystem disease--a case study
Insights
Severe multisystem disease can mimic brain death. This case highlights that combining clinical exams with electroencephalograms (EEGs) is crucial for diagnosing cerebral hypofunction, not relying on either alone.
Area of Science:
- Neurology
- Critical Care Medicine
- Pediatrics
Background:
- Diagnosing brain depression in severe multisystem disease is challenging, especially with artificial life support.
- Multisystem disease can present with symptoms that simulate brain death.
- Cerebral cortical activity can be significantly depressed in critically ill patients.
Abstract:
Brain depression in a patient with severe multisystem disease can be a diagnostic challenge, particularly when the patient is maintained on artificial life-support systems. A case report is presented of a 13-year-old girl with severe pneumonia who was treated with prolonged cardiopulmonary bypass during which time she developed a clinical picture simulating brain death with marked depression of cerebral cortical activity on two successive EEGs. Following correction of some of her metabolic defects, the patient showed marked improvement of cortical function. Multisystem disease can be so severe as to produce a clinical picture of brain death. We wish to emphasize that brain hypofunction of depression is best evaluated by both clinical examination and the EEG, and that neither one alone is sufficient to conclude that cerebral death has occurred.