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Brain Dead or Alive: A Case Report of Inaccurate Neurological Prognostication
Danielle A Bazer1,2, Matthew Orwitz2, Nicholas Koroneos2
1Neurology/Neuro-Oncology, Johns Hopkins University, Baltimore, USA.
Cureus
|January 13, 2025
Summary
A misdiagnosis of irreversible brain injury led to organ donation plans. This case highlights critical gaps in brain death determination, emphasizing the need for standardized medical criteria.
Area of Science:
- Neurology
- Neuroscience
- Medical Ethics
Background:
- Brain death diagnosis lacks uniform criteria, leading to diagnostic challenges.
- Systemic lupus erythematosus (SLE) patient experienced cardiac arrest and anoxic brain injury.
- Initial diagnosis of irreversible anoxic brain injury was made at an outside hospital.
Observation:
- Electroencephalogram (EEG) showed abnormal posterior fields and later lateralized periodic discharges.
- Brain magnetic resonance imaging (MRI) was normal.
- Patient survived terminal extubation and was transferred for prognostication.
Findings:
- Treatment for infections and medication adjustments led to EEG normalization.
- Patient recovered neurological function, including ambulation and conversation.
- The patient provided consent for this case report one year post-discharge.
Implications:
- Highlights limitations in current legal frameworks for brain death determination.
- Underscores the urgent need for standardized medical criteria in diagnosing neurological injury.
- Erroneous prognostication can lead to critical errors in life-or-death clinical decisions.
