[Clinical neurological findings in brain-dead patients]

Most of university hospitals have their own criteria for brain death, based on the national criteria. Here the term "brain death" has been restricted to cases with irreversible deep coma and lack of spontaneous respiration secondary to "total destruction of the brain" for which the cause of the primary brain disease should be known and the most vigorous treatments have been given in vain. In evaluating patients with brain death, careful and accurate neurological examinations are mandatory. The level of consciousness should be in deep coma even after deep painful stimuli, without any movements including decorticate and decerebrate postures. The absence of spontaneous respiration is a crutial determinant for the diagnosis. The more sophisticated apnea testing has been standardized for clinical use. This will be discussed by another speaker. However, unusual spontaneous upper limb movements, called "Lazarus' sign", should be appreciated by examiners. This complex spinal movements need not exclude brain death. Brainstem functions such as reactivity of pupils, corneal reflex, ocular motility, pharyngeal reflex and cough reflex should be totally absent for the diagnosis. The isoelectric EEG is a predictor of brain death, if the technical requirements are carefully followed. But according to our experiences, brain-dead patients may have several waves on BAEP recordings even after obtaining a flat EEG. Because of this, BAEP examination and absence of the cerebral circulation were included in our criteria for brain death.