Adult ; Brain Death ; diagnosis ; China ; Guidelines as Topic ; standards ; Humans

In brain death state, bilateral pupil light reflexes are disappeared, and pupils are fixed with dilated. However, spontaneous movements such as ocular microtremor or bilateral cyclical constriction-dilatation of pupils have been rarely reported in brain death patients. We present a brain death patient whose right pupil displayed spontaneously repetitive constriction and dilatation regardless of external stimuli such as light and pain. Early recognition of this phenomenon may prohibit the delay in the diagnosis of brain death and organ transplantation.
Brain Death ; Brain ; Coma ; Constriction ; Diagnosis ; Dilatation ; Humans ; Organ Transplantation ; Pupil ; Reflex ; Transplants

Brain death is a clinical diagnosis that implies irreversible loss of function of the entire brain, including the brainstem and both hemispheres. It is not uncommon for reflex and spontaneous movements to occur in patients with impending brain death during the process of determining brain death. When physicians charged with judging brain death witness such movements during this period, unless they know how common these movements are and what they mean, it will be difficult for them to make an appropriate determination of brain death. Movements following brain death have been reported in previous studies of various types, including cohort studies and case series or reports. However, only a few studies have employed verified diagnostic tools and neurological examinations as a standard protocol when diagnosing brain death. According to previous reports, the frequency of these movements ranges from 19.2% to 75.0% of all brain death cases. These reports have also described which movements are commonly seen. However, it is difficult to determine conclusively where these movements originate, i.e., in the spinal cord or in the cerebral motor cortex, and how such information should be considered in determining brain death. Although limited information is available on the characteristics and pathophysiological mechanism of these movements, it will help physicians to diagnose brain death correctly if they obtain sufficient knowledge about them.
Brain Death ; Brain Stem ; Brain ; Cohort Studies ; Diagnosis ; Humans ; Motor Cortex ; Neurologic Examination ; Reflex ; Spinal Cord

Background: Brain death is the irreversible cessation of the function of the brain including the brainstem. In 2013, the Brain Injury Evaluation Quality Control Centre (BQCC) of the National Health and Family Planning Commission issued criteria and practical guidelines for the determination of brain death. This study aimed to evaluate whether the institutions have adopted these guidelines and to make suggestions for the improvement of the current criteria and practical guidelines for brain death determination in China. Methods: Consecutive brain death cases from 44 hospitals were evaluated for summary statistics for the following data: the performance of BQCC criteria and practical guidelines, clinical examination, apnea testing, ancillary testing, and the number of examinations as well as the waiting periods between examinations and details of who determined brain death. Data analysis was conducted from January 2013 to December 2017. Results: A total of 550 cases were obtained. All patients were determined to have deep coma and met the prerequisites for clinical testing. The performance rates of four brainstem reflex examinations (except cough reflex) ranged from 97.5% to 98.0%, and the completion rate as well as the coincidence rate were both 100.0%. The 238 cases (50.7%) completed apnea testing, and 231 cases (42.0%) had to stop apnea testing during the examination because of instability. The performance rates of the three ancillary tests, including electroencephalogram, short-latency somatosensory evoked potential, and transcranial Doppler, were 89.5%, 67.5%, and 79.5%, respectively; furthermore, the coincidence rates were 98.6%, 96.5%, and 99.5%, respectively. The combination of two ancillary tests was more accurate than one single ancillary test. A total of 401 (72.9%) cases successfully underwent two separate examinations to determine brain death with at least a 12-h waiting period. All brain death cases were determined by at least two qualified physicians. Conclusion This study might provide suggestions for brain death determination in China.
Brain Death ; diagnosis ; physiopathology ; Electroencephalography ; Evoked Potentials, Somatosensory ; Humans ; Ultrasonography, Doppler, Transcranial

After the Organ Transplant Act was enforced in 2000, the criteria for the diagnosis of brain death have been legalized, and cardiac transplantation has become a promising treatment choice for patients with chronic heart disease. Even though more than hundreds of cases have been accumulated in the national registry and the survival rates are increasing, the compliance of long-term survivors may decrease paradoxically, which can hinder the efforts to enhance the quality of the registry. The patients who are lost from the doctor's surveillance and die outside hospitals should be appropriately examined to determine the cause of death so that the influence of their medical condition, if any, on their death could be revealed. Here, we report an autopsy case of a patient who died of a complication of chronic rejection after cardiac transplantation.
Allografts ; Autopsy ; Brain Death ; Cause of Death ; Compliance ; Coronary Vessels ; Diagnosis ; Graft Rejection ; Heart Diseases ; Heart Transplantation ; Humans ; Myocardial Infarction ; Survival Rate ; Survivors ; Transplants

The diagnosis of brain death is essential for deceased donor organ transplantation. Currently, extracorporeal membrane oxygenation (ECMO) is used to increase the chance of survival of patients with severe cardiac and respiratory failure. Therefore, cases of ECMO-dependent potential donors are increasing. The apnea test (AT) is a mandatory component in the clinical determination of brain death. However, conventional AT is not easily applicable to ECMO-dependent potential donors because both the ventilator and ECMO play an important role in carbon dioxide elimination. Accordingly, different methods of AT from those used in routine procedures must be considered. We report here a case of conventional AT with time delay and two cases of AT within 3 minutes by adjusting sweep gas flow rate of ECMO in ECMO-dependent potential donors.
Apnea* ; Brain Death ; Carbon Dioxide ; Diagnosis ; Extracorporeal Membrane Oxygenation ; Humans ; Membranes* ; Organ Transplantation ; Respiratory Insufficiency ; Tissue Donors* ; Transplants ; Ventilators, Mechanical

Lazarus sign, a complex reflex movement of the upper limbs after brain death, is a rare occurrence. We report two patients who showed a Lazarus sign following a diagnosis of brain death. It has been accepted that cardiac arrest usually occurs within 1 week after brain death; however, the two patients described herein survived for over 100 days after brain death was diagnosed. This report is intended to examine the relationship between the Lazarus sign and long-term survival after brain death, as well as to share our rare experience.
Brain Death ; Brain Stem ; Diagnosis ; Heart Arrest ; Humans ; Reflex ; Upper Extremity

OBJECTIVE: Head injury is a leading cause of death and disability in subjects who suffer a traumatic accident. Contralateral hematomas after surgery for traumatic brain injury are rare. However, an unrecognized, these hematomas can cause devastating results. We presented our experience of these patients and discussed diagnosis and management. METHODS: This study included 12 traumatic patients with acute traumatic brain injury who developed delayed contralateral hematoma after evacuation of an acute hematoma. Clinical and radiographic data was obtained through review of medical records and radiographs retrospectively. RESULTS: Ten males and two females were included in the study. Ten (83.3%) patients had severe head injury (Glasgow Coma Scale [GCS] score <8). Intraoperative brain swelling during removal of the traumatic subdural hematoma was noted in 10 (83.3%) patients. A skull fracture on the side contralateral to the acute hematoma was noted on computed tomography (CT) scans of nine (75%) patients. Three (33.3%) patients with severe head injury (GCS <8) died. Only (10%) one patient with a severe head injury had less severe disability. CONCLUSION: A postoperative CT scan is essential in patients with acute traumatic brain injury and a contralateral skull fracture or a low GCS score. Our results indicated that it is very important to evaluate this rare but potentially devastating complication.
Brain Edema ; Brain Injuries* ; Cause of Death ; Coma ; Craniocerebral Trauma ; Craniotomy ; Decompressive Craniectomy ; Diagnosis ; Female ; Hematoma* ; Hematoma, Subdural ; Humans ; Male ; Medical Records ; Postoperative Hemorrhage ; Retrospective Studies ; Skull Fractures ; Tomography, X-Ray Computed

OBJECTIVE: The aims of the Korean Neuro-Trauma Data Bank System (KNTDBS) are to evaluate and improve treatment outcomes for brain trauma, prevent trauma, and provide data for research. Our purpose was to examine the mortality rates following traumatic brain injury (TBI) in a retrospective study and to investigate the sociodemographic variables, characteristics, and causes of TBI-related death based on data from the KNTDBS. METHODS: From 2010 to 2014, we analyzed the data of 2617 patients registered in the KNTDBS. The demographic characteristics of patients with TBI were investigated. We divided patients into 2 groups, survivors and nonsurvivors, and compared variables between the groups to investigate variables that are related to death after TBI. We also analyzed variables related to the interval between TBI and death, mortality by region, and cause of death in the nonsurvivor group. RESULTS: The frequency of TBI in men was higher than that in women. With increasing age of the patients, the incidence of TBI also increased. Among 2617 patients, 688 patients (26.2%) underwent surgical treatment and 125 patients (4.7%) died. The age distributions of survivors vs. nonsurvivor groups and mortality rates according the severity of the brain injury, surgical treatment, and initial Glasgow Coma Scale (GCS) scores were statistically significantly different. Among 125 hospitalized nonsurvivors, 70 patients (56%) died within 7 days and direct brain damage was the most common cause of death (80.8%). The time interval from TBI to death differed depending on the diagnosis, surgical or nonsurgical treatment, severity of brain injury, initial GCS score, and cause of death, and this difference was statistically significant. CONCLUSION: Using the KNTDBS, we identified epidemiology, mortality, and various factors related to nonsurvival. Building on our study, we should make a conscious effort to increase the survival duration and provide rapid and adequate treatment for TBI patients.
Age Distribution ; Brain ; Brain Injuries* ; Cause of Death ; Diagnosis ; Epidemiology* ; Female ; Glasgow Coma Scale ; Humans ; Incidence ; Male ; Mortality* ; Retrospective Studies ; Survivors

OBJECTIVES: To explore the value of mast cell tryptase and brain natriuretic peptide（BNP） in the differential diagnostic of sudden death due to hypersensitivity and coronary atherosclerotic heart disease. METHODS: Totally 30 myocardial samples were collected from the autopsy cases in the Department of Forensic Pathology, Shanxi Medical University during 2010-2015. All samples were divided into three groups： death of craniocerebral injury group, sudden death of hypersensitivity group and sudden death of coronary atherosclerotic heart disease group, 10 cases in each group. Mast cell tryptase and BNP in myocardium were detected by immunofluorescence staining and Western Blotting. RESULTS: Immunofluorescence staining showed that the positive staining mast cell tryptase appeared in myocardium of sudden death of hypersensitivity group and coronary atherosclerotic heart disease group. Among the three groups, the expression of mast cell tryptase showed significantly differences through pairwise comparison （P<0.05）; The expression level of BNP in sudden death of coronary atherosclerotic heart disease group were significantly higher than the sudden death of hypersensitivity group and death of craniocerebral injury group （P<0.05）. The difference of the expression level of BNP between the sudden death of hypersensitivity group and the death of craniocerebral injury group had no statistical significance （P>0.05）. CONCLUSIONS The combined detection of the mast cell tryptase and BNP in myocardium is expected to provide help for the forensic differential diagnosis of sudden death due to hypersensitivity and coronary atherosclerotic heart disease.
Anaphylaxis ; Autopsy ; Blotting, Western ; Case-Control Studies ; Coronary Artery Disease/complications* ; Death, Sudden, Cardiac/etiology* ; Diagnosis, Differential ; Fluorescent Antibody Technique ; Forensic Pathology ; Humans ; Male ; Myocardial Infarction ; Myocardium/metabolism* ; Natriuretic Peptide, Brain/metabolism* ; Tryptases/metabolism*