Mimickers of Brain death

Q: All of the following can mimic brain death scenario and should be ruled out before declaring a patient brain dead except? 

A) Upper limb pronation extension reflex
B) Locked-in syndrome
C) Hypothermia 
D) Drug intoxication 
E) Guillain-Barré syndrome


Answer: A

Upper limb pronation extension reflex originates from the spinal cord or peripheral nerve and may occur in brain death. All other situations (choices B, C, D, and E) may mimic brain death where a patient is actually not dead.

#braindeath
#endoflifecare


References:

1. Saposnik G, Bueri JA, Mauriño J, et al. Spontaneous and reflex movements in brain death. Neurology 2000; 54:221. 

2. Beckmann YY, Ciftçi Y, Seçil Y, Eren S. Fasciculations in brain death. Crit Care Med 2010; 38:2377.

3. Patterson JR, Grabois M. Locked-in syndrome: a review of 139 cases. Stroke 1986; 17:758. 

4. Danzl DF, Pozos RS. Accidental hypothermia. N Engl J Med 1994; 331:1756. 

5. Stojkovic T, Verdin M, Hurtevent JF, et al. Guillain-Barré syndrome resembling brainstem death in a patient with brain injury. J Neurol 2001; 248:430.