Brain Dead or Alive: A Case Report of Inaccurate Neurological Prognostication

Although numerous definitions of brain death exist, the diagnosis and diagnostic process remain open to interpretation. We present the case of a 32-year-old male with systemic lupus erythematosus who presented to an outside hospital following a cardiac arrest while jogging. His electroencephalogram (EEG) showed abnormal contour in the posterior fields. Despite the patient's normal brain magnetic resonance imaging (MRI), the treating neurological team diagnosed him with anoxic brain injury based on his persistently comatose exam and abnormal EEG. With neurological guidance, the patient's family elected for terminal extubation and organ donation. He surprisingly survived the terminal extubation and was transferred to our hospital for prognostication. His EEG showed lateralized periodic discharges, prompting medication adjustments. He was also treated for multiple infections. With treatments, his EEG normalized, and he ultimately ambulated, conversed, and consented for this case report one year following discharge. The lack of uniformity on how to approach comatose patients with presumed irreversible neurologic injury can lead to inaccurate prognostication and guide life-or-death clinical decisions. This case of erroneous assessment highlights the marked limitations of the current legal framework for determining brain death and the need for standardized medical criteria.