Primary brainstem death: a clinico-pathological study

A case of primary brainstem death in a man with surgically treated cerebellar haemorrhage is reported. Necropsy revealed extensive necrosis confined to the brainstem and cerebellum. The absence of diabetes insipidus and the persistence of electroencephalographic activity were the characteristic clinical features of the case. This differentiates the condition from so-called "whole brain death". Analysis of three further cases with acute vascular lesions of the brainstem or cerebellum, shown at necropsy, revealed that primary brainstem death with prolonged somatic survival can occur in specific circumstances after surgical intervension.