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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.
Abstract:
Introduction and Case Presentation: Brain death can be associated with limb movements that are attributed to spinal reflexes. Although head/face movements have been rarely reported, no case of overt eye movements in brain death has been documented. We report a case of a patient with subtle eye movements whose exam was otherwise consistent with brain death. The presence of eye movements delayed pronouncing the patient as brain dead and delayed organ donation. We agree with American Academy of Neurology Position statement from 2019 that brain death does not mean demise of every neuron. Discussion: This case raises important questions about the types of movements that should be "allowed" during the determination of brain death to avoid delays in diagnosis.
Insights
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.
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.
