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Brain Death, Decorticate Posturing, Persistent Vegetative State and Locked-In Syndrome

by Carlo Raj, MD
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    Brain death, irreversible cessation of brain and brainstem functioning, regardless of cause. Requirements varies from, well, state to state, hospital to hospital. Comatose, absence of brainstem reflexes that we talked about. No spontaneous respiration. Absence of complicating factors: Hypothermia, sedatives, metabolic abnormalities. Approach to brain death. Here, we have an algorithm or flow chart. And from the flow chart, on the top, we go from the coma. Is it present? And if it is, your next step of management is going to be neuroimaging and maybe CSF evaluation, as long as intracranial pressure is not elevated. If you find something to be interesting, yes, then you want to start thinking about how to rule things out. Was it hypothermia? Was it intoxication? Was it sedatives? Or was it neuromuscular blocking type of agents? Was it metabolic in terms of severe electrolyte disturbances? Was it acid-based disturbance? Or was it endocrine type of crises such as Addison’s disease? If there is something that you find to be yes with one of these differentials, then absence of brainstem reflexes and motor response. So here, what we mean by this is the brainstem reflex such as a pupillary or the cold caloric or the doll’s eye, whatnot. And we have apnea with the PCO2 being elevated. Remember the PCO2 should be normally around 40. And so therefore, if your brainstem isn’t functioning properly, there is every possibility that you might be then retaining carbon dioxide. Next, what would you do? Clinical diagnosis of brain death is what you’re thinking. At this point, maybe, maybe, there is eligible for organ type of harvesting, because now at this point, you’re thinking about asking the family members or a power-of-attorney as to whether or not the harvesting of organ from your patient is your next step...

    About the Lecture

    The lecture Brain Death, Decorticate Posturing, Persistent Vegetative State and Locked-In Syndrome by Carlo Raj, MD is from the course Altered Mental Status and Coma. It contains the following chapters:

    • Brain Death
    • Decorticate Posturing
    • Persistent Vegetative State & Locked-In Syndrome

    Included Quiz Questions

    1. Bradycardia.
    2. Absence of spontaneous breathing.
    3. Absence of brainstem reflexes.
    4. Coma.
    5. Oculocephalic reflex.
    1. Above the red nucleus.
    2. Below the red nucleus.
    3. Near the basal ganglia.
    4. In the brain stem.
    5. Hippocampus.
    1. Locked-In Syndrome, pons.
    2. Persistent vegetative state, pons.
    3. Coma, midbrain.
    4. Locked-In Syndrome, midbrain.
    5. Locked-In Syndrome, medulla oblongata.

    Author of lecture Brain Death, Decorticate Posturing, Persistent Vegetative State and Locked-In Syndrome

     Carlo Raj, MD

    Carlo Raj, MD


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