The Diagnosis Of Brain Death: Six Signs And Symptoms
The brain is the master computer for all of your functions, so if it has failed, theres no wonder that almost all bodily functions will be impacted along with it. Its possible for a person to appear to still be alive when their brain is no longer functioning, but a brain-dead person is not legally considered to be alive.
That means while the patient is still breathing and their heart is beating, their brain has called it quits. This is a situation that can occur after a patient has been placed on life support, and is not the same as a coma , notes the Better Health Channel in Australia. Here are six signs of brain death
The Heart Will Stop Beating Without A Ventilator
An article from LiveScience explains that some cases of brain death can be especially tough on families, because some of the bodily functions such as a heartbeat continue after brainwave activity has been shown to be absent.
In fact, the heart has an intrinsic electrical system that allows it to continue beating without assistance from the brain, and it can even continue beating outside of the body, it adds. However, without the assistance of a ventilator providing a continuous flow of oxygen and blood, this beating would stop very quickly, usually in less than an hour, it notes.
Genes May Remain Active
Even though someone has died, it doesn’t necessarily mean their body’s work is done. “Many genes actually become active in our bodies after our death,” Ira S. Pastor, CEO of life sciences company Bioquark Inc., tells Bustle.
In fact, studies have shown that genes may remain turned on days after an animal dies, and researchers are looking into how this may help preserve donated organs for plantation.
“Interestingly, many of these genes have been identified as embryonic/fetal development genes, almost as if the genome is ‘shouting out’ to try to tell the body to ‘go back in time’ and start life over again,” Pastor says. Interesting, right?
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Spontaneous Movements Often Occur After Brain Death
- American Academy Of Neurology
- Many brain-dead patients have spontaneous movements such as jerking of fingers or bending of toes that can be disturbing to family members and health care professionals and even cause them to question the brain-death diagnosis. These movements occur in 39 percent of brain-dead patients, according to a study published in the January 11 issue of Neurology, the scientific journal of the American Academy of Neurology.
ST. PAUL, MN – Many brain-dead patients have spontaneous movements such as jerking of fingers or bending of toes that can be disturbing to family members and health care professionals and even cause them to question the brain-death diagnosis. These movements occur in 39 percent of brain-dead patients, according to a study published in the January 11 issue of Neurology, the scientific journal of the American Academy of Neurology.
We found that these movements are more common than has been reported or believed, said neurologist and study author José Bueri, MD, of J. M. Ramos Mejia Hospital in Buenos Aires, Argentina. People need to know that these movements are spinal reflexes that do not involve any brain activity.
The study examined all patients at the hospital during an 18-month period with a diagnosis of brain death. Of the 38 patients, 15 had these motor movements. In all cases, the movements were seen in the first 24 hours after brain death diagnosis, and no movements were seen after 72 hours.
What Does Brain Death Mean
Brain death is a legal definition of death. It is the complete stopping of all brain function and cannot be reversed. It means that, because of extreme and serious trauma or injury to the brain, the body’s blood supply to the brain is blocked, and the brain dies. Brain death;is;death. It is permanent.
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Does The Definition Need To Be Changed
Under this definition, Jahi McMath was dead at the time she was examined.
She was unable to respond to any of the reflex tests and unable to breathe on her own. Her brainstem, at the very least, appears to be damaged or destroyed.
Christopher Dolan, attorney for Jahi and her mother, doesnt dispute the initial test results.
She didnt pass any of the tests. She failed all the tests, he said in an interview with Healthline.
However, he also argues that she was far from meeting the criteria for stability that the brain death test requires.
She was certainly not in any condition to be tested, Dolan said. This was a young girl who hadnt eaten in 26 days. No food. They stopped providing her with any type of treatment designed to maintain her existence. I am of the firm belief that they were hoping she would die so the legal case would become moot.
Dolan added Jahi has had serious lung infection, ulcers, and kidney issues.
She was just this side of dead, said Dolan. So she wasnt in any kind of optimum condition to be evaluated.
Even if another test were to be performed now, more than a year later, Dolan isnt convinced that the test can measure whats going on in Jahis brain.
Now, to this date, she still may fail standard neurological testing, and the question then becomes, is the standard neurological testing adequate or is it too crude? he asked.
According to Dolan, although Jahis brainstem isnt responding, that doesnt mean that the rest of her brain is dead.
The Patient Cant Breathe On Their Own
One major telltale sign of brain death is that the mechanism in the brain that keeps you breathing when youre not conscious wont kick in. That means to get a diagnosis of brain death, doctors will often see if a patient can breathe unassisted, notes the National Kidney Foundation.
During the tests to determine brain dead status, the patient is placed on a ventilator and may be given medications to maintain blood pressure and other bodily functions. During the brain death testing, the ventilator and medications continue but they do not affect the results of the testing, it notes.
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Brain Death Is Different From Vegetative State
The difference between brain death and a;vegetative state, which can happen after extensive brain damage, is that it’s possible to recover from a vegetative state, but brain death is permanent.
Someone in a vegetative state still has a functioning brain stem, which means:
- some form of consciousness may exist
- breathing unaided is usually possible
- there’s a slim chance of recovery because the brain stem’s core functions may be unaffected
Someone in a vegetative state can show signs of being awake. For example, they may open their eyes but not respond to their surroundings.
In rare cases, a;person in a vegetative state may show some sense of response that can be detected using a brain scan, but not be able to interact with their surroundings.
Donation After Brain Death
Families of a brain dead patient must, by federal regulations, be provided the option of organ donation. If the family declines donation, the mechanical ventilator, medications and fluids are discontinued, after which the heart stops. If the family says yes to donation, the regional organ procurement organization is involved. The donors body is kept functioning by artificial means, such as ventilated support until the recovery of organs and tissue for life-saving transplant.
If you support donation it is important to document your decision. This removes the burden off of your loved ones to make the decision once you have passed away.
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How Can We Tell If A Comatose Patient Is Conscious
Neurologist Steven Laureys looks for signs of consciousness in unresponsive patients
Steven Laureys greets me with a smile as I enter his office overlooking the hills of Liège. Although his phone rings constantly, he takes the time to talk to me about the fine points of what consciousness is and how to identify it in patients who seem to lack it.
Doctors from all over Europe send their apparently unconscious patients to Laureysa clinician and researcher at the University of Liègefor comprehensive testing. To provide proper care, physicians and family members need to know whether patients have some degree of awareness. At the same time, these patients add to Laureys understanding. The interview has been edited for clarity.
What is consciousness?
It is difficult enough to define life, even more so to define conscious life. There is no single definition. But of course, in clinical practice we need unambiguous criteria. In that setting, everyone needs to know what we mean by an unconscious patient. Consciousness is not all or nothing. We can be more or less awake, more or less conscious. Consciousness is often underestimated; much more is going on in the brains of newborns, animals and coma patients than we think.
So how is it possible to study something as complex as consciousness?
What processes in the brain create consciousness?
What happens in a comatose person?
How do we know whether a coma patient who has awakened is conscious?
Was It Really Brain Death
Twenty-one-year-old Zack Dunlap from Oklahoma appeared on NBC’s Today Show;in 2008 to tell an incredible story of hearing a physician telling his parents that a PET scan confirmed that he was brain dead after a catastrophic brain injury. While he was being prepared for organ donation, however, he moved his arm purposely in response to stimuli. Dunlap recovered, went to a rehabilitation hospital, and ultimately went home 48 days later, very much alive.
Earlier this year, 13-year-old Trenton McKinley from Alabama and his parents hit the media circuit to talk about the miracle of Trenton awakening after being declared brain dead from a vehicle accident1 day before his organs were scheduled to be harvested.
The likely explanation for such “recoveries” from brain death, according to experts, is that these individuals were never brain dead in the first place. “Errors have been made where people declared brain dead were later found to have spontaneous movement that should not have been possible,” says Robert M. Sade, MD, professor of surgery and director of the Institute of Human Values in Health Care at the Medical University of South Carolina in Charleston. “In virtually all those cases, brain-death determination was not done correctly. If you don’t go through the exact protocol for brain-death determination, you’re likely to have patients diagnosed as being dead by neurologic criteria who are, in fact, not brain dead.”
- Was It Really Brain Death?
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Tests To Confirm Brain Death
Although rare, a few things can make it appear as though someone is brain dead.
These include drug overdoses and severe;hypothermia, where body temperature drops below 32C.
A number of tests are carried out to check for brain death, such as shining a torch into both eyes to see if they react to the light.
Pvs Brain Death And Advance Directives
Those who end up in a persistent vegetative state are, of course, unable to tell doctors whether they would like to remain on life support. The best way to ensure that your end-of-life wishes are honored is to create a living will while you are still healthy.
A living will is a legal document that dictates how you would like to be cared for in the event of an incapacitating injury, such as that resulting in a PVS. If you would like to die naturally, by removal of a feeding tube or ventilator, all parties are legally required to follow your wishes.
The durable power of attorney, meanwhile, grants decision-making authority to a trusted individual named in the document. This person must adhere to your living will, but legally may make other important decisions not specifically covered in the living will. Some states refer to the combination of a living will and durable power of attorney as an “advance directive.”
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What’s The Legal Meaning Of Persistent Vegetative State
An individual with severe cerebral damage who has been in a chronic state of unconsciousness for at least four weeks is considered to be in a persistent vegetative state . It sometimes is confused with a coma, but comatose patients are never conscious . PVS can be a controversial diagnosis, since patients with locked-in syndrome are fully conscious, but similarly unable to communicate or respond to stimuli.
A patient considered “highly unlikely” to live beyond a vegetative state, after having gone through rigorous testing, may be diagnosed as being in a persistent vegetative state. It’s not impossible for PVS patients to recover higher brain functions, just extremely rare and largely dependent on the cause and nature of the brain injury. But the chance of recovery after three months is very small.
If the doctors believe there is little to no chance of recovery, then family and loved ones may seek a court order to remove the patient from life support . In the absence of a court order or a DNR, the hospital is obligated to keep the patient alive through artificial means until further notice.
What Happens To An Individual While These Tests Are Being Done
The individual is placed on a machine that breathes for him or her, called a ventilator. This machine is needed because the brain can no longer send signals telling the body to breathe. Special medications to help maintain blood pressure and other body functions may also be given. During the brain death testing, the ventilator and medications continue but they do not affect the results of the testing.
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Causes Of Brain Death
Brain death can happen when the blood and/or oxygen supply to the brain is stopped.
This can be caused by:
- cardiac arrest ;;when the heart stops beating and the brain is starved of oxygen
- a heart attack; when the blood supply to the heart is suddenly blocked
- a stroke;;when the blood supply to the brain is blocked or interrupted
- a blood clot;;a blockage in a blood vessel that disturbs or blocks the flow of blood around your body
Brain death can also be caused by:
When You Die You Know You’re Dead Because Your Brain Still Works
When you die you know you’re dead because the brain keeps functioning and you know what’s happening around you, chilling new research suggsts .
Medical experts have long debated what happens when a person dies, with anecdotal evidence of bright lights or sensations, and films such as Flatliners exploring the unknown.
But a new study suggests a person’s consciousness keeps working after their heart stops beating and their body movements fail.
Cardiac arrest survivors were aware of what was going on around them while they were ‘dead’ – including seeing doctors trying to save them or hearing conversations – before being ‘brought back to life’, the study revealed.
It means that a person may even hear their time of death being announced by medics as they are essentially ‘trapped’ inside their body with brain function.
Dr Sam Parnia is studying consciousness after death and examining cardiac arrest cases in Europe and the US.
He said anecdotal evidence has found that people in the first phase of death may still experience some form of consciousness.
The expert told LiveScience that people who have survived cardiac arrest later accurately described what was happening around them after their hearts stopped beating.;
He said: “They’ll describe watching doctors and nurses working, they’ll describe having awareness of full conversations, of visual things that were going on, that would otherwise not be known to them.”
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An Argument Of Awareness
Dolan also reports other evidence that Jahi has some degree of not just life but awareness.
Heart rate variability studies have been done that show that when her mother comes into the room and talks to her, her heart rate goes up, he said.
He added there are videos from the family that demonstrate Jahi responds to her mothers commands.
This is in direct response to her mothers voice. These are indications of a sentient being, not just a pound of flesh in a refrigerator, he said.
Something like that can happen with patients who are brain dead, Magnus responded. Theres still electrical activity going on. Theres still respiration going on. Theres still muscles that are being activated, so all thats still taking place, so all that can still happen.
But he said its really something people are seeing thats not there.
Ive been involved in those cases where families just cant understand the concept of brain death, and they dont initially accept that their loved one has passed away or they struggle with that, he said.
Magnus doesnt see anything wrong with the current criteria for brain death and agrees the definition should remain in the hands of medical specialists.
However, the medical community isnt fully united on what constitutes brain death.
One of Dolans experts, Dr. Calixto Machado, Ph.D., of the Institute of Neurology and Neurosurgery in Havana, Cuba, is spearheading a movement to make the whole brain approach the norm for medicine.
Establishing The Irreversibility And Cause Of The Coma
Before a doctor can determine whether the coma is irreversible, he or she must find if there is any way to reverse it. To do so, the medical team must first pinpoint the cause of the coma.
Moreover, the team must exclude any condition that could potentially mimic brain death, such as hypothermia, drug toxification or poisoning, metabolic abnormalities, or neuromuscular agents that can cause “death-like” paralysis. All of these, by varying degrees, are potentially reversible.
Establishing the irreversibility of a coma requires that the doctor wait an appropriate amount of time based on the known or proximate cause. The determination that must meet both medical and legal standards. From this perspective, the term “proximate” indicates that the cause must be sufficiently established and supported if it is not already known.
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