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A clinico-neuropathological study on brain death

N Ujihira1, Y Hashizume, A Takahashi

  • 1Department of Neurology, Nagoya University School of Medicine, Japan.

Nagoya Journal of Medical Science
|November 1, 1993
PubMed
Summary

This study examined 60 brain death cases, revealing neuropathological changes like edema and herniation. Autolysis was prominent, but underlying diseases were still diagnosable, distinguishing brain death from other conditions.

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Area of Science:

  • Neuropathology
  • Forensic Neurology

Background:

  • Brain death diagnosis relies on clinical criteria, but neuropathological changes provide crucial insights.
  • Understanding post-mortem changes is vital for accurate diagnosis and differentiating causes of death.

Purpose of the Study:

  • To conduct a clinico-neuropathological examination of brain death cases.
  • To characterize the histological findings in brain death and correlate them with duration and underlying causes.
  • To differentiate neuropathological features of brain death from cardiac arrest-induced encephalopathy and postmortem changes.

Main Methods:

  • Clinico-neuropathological study of 60 brain death cases (36 males, 24 females; age 11-81 years).
  • Analysis of brain weight, macroscopic findings (edema, congestion, herniation, hemorrhage), and microscopic features (neuronal, white matter, glial changes).

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  • Correlation of autolysis degree with brain death duration and underlying disease.

    • Main Results:

    • Common findings included brain edema, congestion, herniation, and subarachnoid hemorrhages.
    • Histology showed pale neurons, pale myelin staining, and shrunken glial nuclei.
    • Prominent autolysis was observed in the cerebral cortex, thalamus, brain stem, cerebellum, and pituitary gland.
    • No reactive astrocytosis or inflammatory cell infiltration was noted, except for transient neutrophil infiltration in 8 cases.
    • Autolysis correlated with brain death duration but not the underlying disease.
    • Underlying diseases were diagnosable despite brain death.
    • Histological features differed from cardiac arrest-induced encephalopathy and long postmortem changes.

    Conclusions:

    • Brain death exhibits characteristic neuropathological changes, including significant autolysis.
    • Despite autolysis, neuropathological diagnosis of the primary insult is often possible.
    • Histological findings in brain death are distinct from other neurological conditions and postmortem degradation.