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  1. Home
  2. Lazarus Sign, A Misnomer To An Anatomical Spinal Reflex.
  1. Home
  2. Lazarus Sign, A Misnomer To An Anatomical Spinal Reflex.

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Lazarus Sign, a Misnomer to an Anatomical Spinal Reflex.

Sabrina Costantini1, Joe Iwanaga2, Trifon Totlis3

  • 1Department of Anatomical Sciences, St. George's University, School of Medicine, West Indies.

Clinical Anatomy (New York, N.Y.)
|April 17, 2025

View abstract on PubMed

Summary
This summary is machine-generated.

The Lazarus sign, a spinal reflex in brain-dead patients, involves limb movements originating from the spinal cord, not the brain. This reflex, seen in up to 40% of cases, aids in accurate brain death diagnosis.

Keywords:
Lazarus signbrain deathbrain stemspinal reflex

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Area of Science:

  • Neuroscience
  • Clinical Neurology
  • Critical Care Medicine

Background:

  • The Lazarus sign, a spinal reflex in brain-dead patients, involves involuntary upper limb movements.
  • Historically, it has been a subject of debate regarding its origin and diagnostic implications.
  • Recent research clarifies its spinal origin, independent of brain activity.

Purpose of the Study:

  • To review and synthesize current knowledge on the Lazarus sign in brain-dead patients.
  • To explore its neurophysiological mechanisms, prevalence, and clinical significance.
  • To address its impact on brain death assessment and end-of-life care communication.

Main Methods:

  • Systematic review of PubMed-indexed studies and backward citations.
  • Inclusion of studies detailing spinal reflexes in brain-dead patients and their mechanisms.
  • Exclusion of studies solely on brainstem activity or lacking methodological detail.
  • Main Results:

    • The Lazarus sign originates solely from the spinal cord, without brainstem or cortical involvement.
    • It presents variably, occurring in up to 40% of brain-dead patients, sometimes involving multiple limbs.
    • The sign does not indicate residual brain function but can be misunderstood.

    Conclusions:

    • The Lazarus sign is a purely spinal reflex, crucial for refining brain death criteria.
    • Accurate recognition and communication are vital to prevent misinterpretation by families and clinicians.
    • Further research should standardize protocols, enhance clinician education, and address ethical considerations.