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Subtle ocular movements in a patient with brain death.

D Fattal¹, J McDaniel², E C Leira²

¹Iowa City VA Medical Center, University of Iowa, Neurology Department, 200 Hawkins Drive, Iowa City, IA 52242.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association

|August 19, 2020

Summary

Subtle eye movements can occur in brain death, potentially delaying diagnosis and organ donation. This challenges the traditional understanding of brain death criteria and highlights the need for nuanced clinical evaluation.

Keywords:

brain death/diagnosis critical care eye movements practice guidelines as topic/standards reflex/physiology tissue and organ procurement

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Area of Science:

Neurology
Neuroscience

Background:

Brain death diagnosis relies on absence of brain function, but spinal reflexes can cause limb movements.
Head and facial movements are rarely reported in brain death cases.

Observation:

This case presents subtle eye movements in a patient otherwise meeting criteria for brain death.
These movements complicated the diagnostic process and delayed organ donation.

Findings:

The presence of eye movements, even subtle ones, can challenge the pronouncement of brain death.
This observation aligns with the understanding that not all neurons may demise in brain death.

Implications:

Clinical protocols for brain death determination may need refinement to account for such movements.
Clarifying "allowed" movements is crucial to avoid diagnostic delays and facilitate timely organ donation.