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Updated: Jan 22, 2026

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What to exclude when brain death is suspected.

Pascale Grzonka1, Kai Tisljar1, Stephan Rüegg2

  • 1Medical Intensive Care Units, University Hospital Basel, Switzerland.

Journal of Critical Care
|July 6, 2019
PubMed
Summary

Diagnosis of brain death requires careful consideration of confounders, especially in cases of intoxication or polyneuritis, where favorable outcomes are possible. Strict adherence to guidelines is crucial for accurate brain death diagnosis.

Keywords:
Brain deathDiagnosisMimicsNeuro-critical carePitfalls

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Area of Science:

  • Neurology
  • Critical Care Medicine
  • Forensic Medicine

Background:

  • Advances in critical care and organ donation highlight the increasing importance of accurate brain death diagnosis.
  • Potential confounders can complicate the clinical presentation and diagnostic approaches in suspected brain death cases.

Purpose of the Study:

  • To assess potential brain death confounders reported in the medical literature.
  • To elucidate the clinical presentation and diagnostic strategies for brain death in the presence of confounding conditions.

Main Methods:

  • A systematic literature search was conducted on PubMed and Embase using 37 predefined search terms.
  • Articles reporting cases, case series, or cohort studies in adult patients were identified and reviewed.

Main Results:

  • Forty case reports/series involving 45 patients with 19 critical conditions were identified from 4769 articles.
  • Intoxications (42%) and polyneuritis (37%) were the most frequent confounders; mortality was 11% and full recovery 33%.
  • Full recovery was more common in intoxication cases, emphasizing the need for awareness.

Conclusions:

  • Brain death confounders are infrequently reported, with a lack of formal studies and high risk of bias.
  • High awareness and strict adherence to diagnostic guidelines are crucial, particularly in cases with favorable outcomes like intoxications.
  • Identifying conditions mimicking brain death before initiating diagnostic tests is essential.