[Uncommon reflex automatisms after brain death]

Two cases of unusual complex movements observed in brain dead patients are described. Rapid and sustained flexion of the neck induced slow abduction of the arms with flexion of the elbows, wrists and fingers over 5 to 10 seconds. These movements have been rarely described and although they have similar clinical patterns, they are pathophysiologically different from the Lazarus sign which is observed few minutes after respiratory support cessation. While Lazarus sign is supposed to be due to an agonal discharge of anoxic spinal neurons, the movements described in this article result probably from complex reflexes generated in a disinhibited spinal cord. It is however surprising that they have never been described in patients with high cervical spinal injuries.