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Thumbs up sign in brain death
Manoj K Mittal1, Grace M Arteaga, Eelco F M Wijdicks
1Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. mittal.manoj@mayo.edu
Insights
A new spinal reflex, the "Thumbs up sign," was observed in a pediatric patient declared brain dead. This finding highlights the importance of recognizing spinal reflexes in brain death to prevent confusion and donation delays.
Area of Science:
- Neurology
- Pediatric Critical Care
Background:
- Spinal reflexes are known to occur in brain death.
- Distinguishing spinal movements from brain-generated movements is crucial.
Observation:
- A case of a five-year-old girl declared brain dead after cardiac arrest is presented.
- She exhibited spinal movements, notably a "Thumbs up sign."
Findings:
- The "Thumbs up sign" represents a novel spinal reflex in the context of brain death.
- These spinal movements can mimic voluntary actions, potentially delaying organ procurement.
Implications:
- The "Thumbs up sign" should be recognized as a spinal reflex in brain death.
- Educating healthcare teams about spinal reflexes can prevent diagnostic errors, family distress, and organ donation impediments.
Introduction:
Spinal reflexes can be seen in the setting of brain death. We present a new spinal reflex. We also review spinal movements in pediatric brain death and provide suggestions to distinguish them from movements generated by the brain.
Case Report:
We report a five-year old girl admitted after an asystolic cardiac arrest and was soon declared brain death as a result of bilateral cerebellar hematoma. She had spinal movements including a "Thumbs up sign". These findings delayed organ procurement.
Conclusion:
"Thumbs up sign" should be added to the list of spinal reflexes seen with brain death. Spinal reflexes in brain death can be clinically recognized and should explained to all involved parties to avoid unnecessary testing, confusion for family members, and delay or refusal of organ donation.
