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Hypothalamic function in patients diagnosed as brain dead and its practical consequences
Michael Nair-Collins1, Ari R Joffe2
1Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, United States.
Handbook of Clinical Neurology
|July 16, 2021
Summary
Brain death diagnosis may not fully capture the absence of all brain function, as some patients show continued neuroendocrine activity. This challenges current brain death testing and management protocols.
Area of Science:
- Neuroscience
- Endocrinology
- Medical Diagnostics
Background:
- Brain death is a clinical diagnosis based on neurologic criteria.
- Some patients declared brain dead exhibit residual neuroendocrine functions.
- This phenomenon complicates the definitive diagnosis of brain death.
Purpose of the Study:
- To review the pathophysiology of brain death concerning neuroendocrine function.
- To examine evidence of continued hypothalamic function post-brain death declaration.
- To discuss implications for brain death testing and management.
Main Methods:
- Literature review of studies on brain death and neuroendocrine function.
- Analysis of potential mechanisms for preserved hypothalamic activity.
- Discussion of clinical management strategies.
Main Results:
- Evidence suggests continued hypothalamic-pituitary function in some brain-dead patients.
- Pathophysiology can lead to either neuroendocrine failure or preservation.
- These findings introduce confounds in brain death assessment.
Conclusions:
- Continued neuroendocrine function challenges the completeness of brain death criteria.
- Further research is needed to understand and manage these cases.
- Management strategies for hypothalamic-pituitary failure in brain death require consideration.
