Related Experiment Videos
A clinico-neuropathological study on brain death
N Ujihira1, Y Hashizume, A Takahashi
1Department of Neurology, Nagoya University School of Medicine, Japan.
Insights
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.
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).
- 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.
Abstract:
A clinico-neuropathological study was conducted on 60 cases of brain death, 36 males and 24 females, ranging in age from 11 to 81 years, the average being 49.4 years. Of these, 29 patients died of cerebrovascular disease. The average duration of brain death was 99 hours. The mean weight of the brain was 1466 g. Neuropathological findings were brain edema, congestion, herniation and various subarachnoid hemorrhages. Histologically, the cytoplasm of neurons was pale and ghost-like. In the white matter, myelin staining was pale, and nuclei of the glial cells were shrunken and piknotic. Autolysis of the cerebellar granular layer and the pituitary gland was evident in all cases. No reactive astrocytosis or infiltration of the cells in or around necrotic tissue could be seen. In eight cases, there was laminar infiltration of neutrophils in the superficial area of the cerebrum and brain stem, possibly due to temporary or partial recirculation. Correlation between the degree of autolysis and duration of brain death was observed, but no relationship between the degree of autolysis and the difference of underlying disease could be found. Autolysis in the cerebral cortex, thalamus, tegmentum of the brain stem, cerebellar granular layer and pituitary gland was most prominent. However, neuropathological diagnosis of underlying diseases could be made even in brain death. Histologically, the cases of brain death differed from those of cardiac arrest-induced encephalopathy and from those of long postmortem autopsy.