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How Long Can You Be Dead Before Brain Damage

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Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

Methamphetamine can cause progressive and sometimes profound damage to the brain. The question is whether the damage is reversible once a person stops using meth. Unfortunately, the answer is rarely simple.

While its possible that some damage will start to reverse when a person stops using meth, other types of damage are harder to turn back. What we do know is that any restoration of brain function is only possible after a sustained period of complete abstinence.

What Exactly Is Lazarus Syndrome

Your heart is a pump that pushes blood through your blood vessels to all your organs and tissues in your body. When it stops beating, circulation stops, and your organs begin to fail because theyre no longer getting oxygen.

Usually, the reason your heart stops cant be corrected or reversed, and death soon follows despite CPR. Sometimes, CPR is successful and restarts your heart, especially if the cause is a reversible problem.

Very rarely, a problem develops during CPR that prevents your heart from restarting. Lazarus syndrome happens when that problem resolves itself shortly after CPR stops, and your heart starts beating again.

Lazarus syndrome is very rare. One 2015 case report found that only 32 cases were reported between 1982 and 2008.

According to the Bible, Lazarus was dead for 4 days before Jesus brought him back to life. In Lazarus syndrome, death doesnt last nearly as long.

According to a , In most documented cases of Lazarus syndrome, circulation typically returned within 10 minutes of stopping CPR.

Many people think that death occurs as soon as the heart stops beating and breathing ceases.

But in fact, death is a process in which all your organs necessary for life progressively fail. You arent actually considered dead until the function of all your organs, including your brain, irreversibly stop.

Most importantly, medical personnel need to confirm the loss of function of multiple organs before declaring death. This includes:

Brain Oxygen Deprivation: The Basics

Doctors typically refer to two distinct forms of oxygen deprivation: anoxic brain injuries occur when the brain is totally deprived of oxygen due to sudden cardiac arrest, choking, strangulation, and other sudden injuries. Hypoxic brain injuries occur when the brain receives less oxygen than it needs, but is not completely deprived of oxygen. Because the effects of the two injuries are similar, many brain experts use the terms interchangeably.

A few seconds of oxygen deprivation won’t cause lasting harm, so a child who holds his breath in frustration, a combatant choked unconscious during a Jiu-Jitsu match, and a diver who needs a few extra seconds to come up for air are unlikely to experience brain damage. The precise timeline of anoxic brain injuries depends on a number of personal idiosyncrasies, including overall brain and cardiovascular health, as well as the level of blood oxygenation at the time of injury. Generally speaking, injuries begin at the one-minute mark, steadily worsening thereafter.

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What Are Anoxic And Hypoxic Brain Injuries

Unlike traumatic brain injuries, in which brain damage is induced by direct physical trauma, anoxic and hypoxic brain injuries are characterized by brain damage from a lack of oxygen to the brain. Anoxic and hypoxic brain injuries are commonly associated with strokes, although strokes are not the only causes of this type of brain damage.

What Are The Long

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The long-term consequences will depend on the severity of the cerebral anoxia and on how much irreversible damage has occurred in the brain. If there has only been mild or short-lived anoxia, there may well be recovery back to a normal or near normal level of functioning.

However, if the anoxic injury has been more marked the outcome is less certain and there are likely to be long-term effects. The nature of these problems will vary from person to person, depending on the severity of the injury and the brain areas affected.

There is considerable overlap with the effects of other kinds of acquired brain injury. However, the selective vulnerability of particular regions of the brain to anoxia also gives some distinctive features to this type of injury. A wide range of difficulties can occur, although not all are necessarily seen in every individual.

Physical effects

Damage to the cerebral cortex, the cerebellum and the basal ganglia may lead to limb weakness and disturbances of movement, balance and co-ordination. There may be spasticity or rigidity, with increased muscle tone. Anoxic injury to the basal ganglia may lead to abnormal movements, including tremor, involuntary writhing movements and brief, jerky movements .

Hormonal imbalances

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Evolution Of The Criteria For Brain Death

Historically death was defined by the presence of putrefaction or decapitation, failure to respond to painful stimuli, or the apparent loss of observable cardio respiratory action. The widespread use of mechanical ventilators that prevent respiratory arrest has transformed the course of terminal neurologic disorders. Vital functions can now be maintained artificially after the brain has ceased to function. In 1968, an ad hoc committee at Harvard Medical School reexamined the definition of brain death and defined irreversible coma, or brain death, as unresponsiveness and lack of receptivity, the absence of movement and breathing, the absence of brain-stem reflexes, and coma whose cause has been identified.

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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What Is Hypoxic Brain Injury / Anoxic Brain Injury

Oxygen is needed for the brain to make use of glucose, its major energy source. If the oxygen supply is interrupted, consciousness will be lost within 15 seconds and damage to the brain begins to occur after about four minutes without oxygen.

A complete interruption of the supply of oxygen to the brain is referred to as cerebral anoxia. If there is still a partial supply of oxygen, but at a level which is inadequate to maintain normal brain function, this is known as cerebral hypoxia. In practice, these two terms tend to be used interchangeably.

For the purposes of consistency, this section of the website will use the terms anoxic brain injury or cerebral anoxia, unless hypoxic injury is specifically meant.

Treatment During A Coma

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During a coma the medical team provides treatment to prevent any further complications. A respirator may be used to assist breathing, and surgery may be required to stop any bleeding or swelling in the brain. There is constant monitoring of vital signs, such as blood pressure and pulse and levels of any prescribed medications.

Other therapies may be used to prevent problems upon awakening from coma. There is a risk of the patient losing their range of motion in their extremities, so the limbs will be moved regularly to avoid spasticity .

Changing the patients position is necessary on a regular basis to prevent pressure sores or skin ulcers, as the patient will not have the reflex actions that prevent these sores from occurring as in someone who is just asleep.

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Certification Of Brain Death

Brain death can be certified by a single physician privileged to make brain death determinations. However, before a patient can become an organ donor, New York State law requires that the time of brain death must be certified by the physician who attends the donor at his death and one other physician, neither of whom shall participate in the process of transplantation. This requirement ensures that all evaluations meet accepted medical standards, and that all participants can have confidence that brain death determination has not been influenced by extraneous factors, including the needs of potential organ recipients.

When two physicians are required to certify the time of death, i.e., when organ donation is planned, both physicians should affirm that the clinical evaluation meets accepted medical standards, and that the data fully support the determination of brain death. Generally, both physicians should observe the patient, review the medical record, and note whether any additional information is required to make a definitive determination. Neither physician should certify brain death unless all aspects of the determination have been completed.

Medical Record Documentation: All phases of the determination of brain death should be clearly documented in the medical record The medical record must indicate:

Using Hightech Tools To Assess Alcoholic Brain Damage

Researchers studying the effects of alcohol use on the brain are aided by advanced technology such as magnetic resonance imaging , diffusion tensor imaging , positron emission tomography , and electrophysiological brain mapping. These tools are providing valuable insight into how alcohol affects the brains structure and function.

Longterm heavy drinking may lead to shrinking of the brain and deficiencies in the fibers that carry information between brain cells . MRI and DTI are being used together to assess the brains of patients when they first stop chronic heavy drinking and again after long periods of sobriety, to monitor for possible relapse to drinking .

Memory formation and retrieval are highly influenced by factors such as attention and motivation . Studies using MRI are helping scientists to determine how memory and attention improve with long-time abstinence from alcohol, as well as what changes take place when a patient begins drinking again. The goal of these studies is to determine which alcoholinduced effects on the brain are permanent and which ones can be reversed with abstinence.

Another hightech tool, electroencephalography , records the brains electrical signals . Small electrodes are placed on the scalp to detect this electrical activity, which then is magnified and graphed as brain waves . These brain waves show realtime activity as it happens in the brain.

The P3 component is reduced in alcoholics compared with control subjects.


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New Rules Spell Out When Doctors Can Let Patients With Brain Damage Die

Guidance on when to withdraw food and water welcomed by many families. But some fear the ethical implications

After Cathy Rentzenbrinks 16-year-old brother Matthew Mintern was knocked over by a car in 1990and sustained a serious head injury, all she could do was hope and pray that he survived. She could tell from the demeanour of the paramedics that it was serious. When he arrived at Pontefract hospital, he had to be resuscitated and then transferred to Leeds General Infirmary to undergo life-saving surgery. I was obsessed with the idea that I didnt want him to die, remembers Rentzenbrink. Of course I realised later there are lots of fates worse than death, but I didnt understand that at the time.

Mintern never woke up. He remained in a vegetative state for eight years until his family went to court for permission to withdraw his feeding tube and allow him to die. His story, which Rentzenbrink tells in her memoir, The Last Act of Love, is far from uncommon.

It is estimated that there are up to 16,000 patients in the UK in a vegetative state where they are awake but show no signs of awareness and perhaps three times that number in a minimally conscious state, where patients have clear but minimal awareness, such as occasionally being able to move a finger. People in these conditions are severely brain damaged and as time goes on, even partial, let alone full recovery, is unlikely. The only thing keeping them alive are their feeding tubes.

What Causes Hypoxic/anoxic Brain Injury


There are many potential causes of cerebral anoxia, including:

  • Cardiac or respiratory arrest
  • Irregular heart rhythm or poor function of the heart muscle after a heart attack, resulting in inefficient supply of blood to the brain
  • Very low blood pressure , resulting from blood loss or disturbed heart function
  • Suffocation
  • Electric shock

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What Is A Cardiac Arrest

Cardiac arrest is the sudden loss of cardiac function, when the heart abruptly stops beating. A person whose heart has stopped will lose consciousness and stop normal breathing, and their pulse and blood pressure will be absent. Unless resuscitative efforts are begun immediately, cardiac arrest leads to death within a few minutes. This is often referred to by doctors as sudden death or sudden cardiac death .

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References And Further Information

Leon-Carrion, J., del Rosario Dominguez-Morales, M., & Dominguez-Roldan, L.M. . Low-level responsive states. In J. Leon-Carrion, K. R. H. von Wild and G. A. Zitney , Brain Injury Treatment: Theories and Practices. New York, NY: Taylor & Francis.

National Health and Research Council. . Post-Coma Unresponsiveness : A Clinical Framework for Diagnosis- An Information Paper.

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Brain Injuries Related To Lack Of Oxygen

There are two major types of such injuries Anoxic and hypoxic brain injury. Anoxic is most often the result of cardiac arrest, near drowning, strangulation, carbon monoxide, smoke inhalation, opiate drug overdose or head trauma. Cardiac arrest is the most common cause of anoxic brain injury. If the oxygen supply is interrupted, consciousness will be lost within 15 seconds while brain cells will slowly start to die after 4 to 5 minutes of oxygen deprivation.

Hypoxic Brain Injuries hypoxic brain injury is a form of hypoxia or oxygen deficiency that affects the brain. It happens when the brain does not receive enough oxygen even though blood is still flowing. Conversly, when oxygen supply is totally cut off, it is called brain anoxia. Brain hypoxia is an absolute medical emergency. Your brain requires a constant supply of oxygen and nutrients to function properly and

Anoxic Brain Injuries anoxic brain injuries are caused by a complete lack of oxygen to the brain, which results in the death of brain cells after approximately four to five minutes after oxygen supply disappears.

What Causes A Lack Of Oxygen To The Brain

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Red blood cells are responsible for carrying oxygenated blood from the lungs through the bodys cardiovascular system and venous systems to the brain and the rest of the body. When something blocks or causes a stoppage or lack of blood flow, such as a blood clot or a prolifically bleeding wound, it prevents this critical supply of oxygen from reaching the brain.

The brain uses about 20% of the bodys oxygen supply, which allows it to perform conscious and autonomic processes.

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Lazarus Syndrome In The News

Only about 63 cases of Lazarus syndrome have been documented in medical journals. Some of these cases have made it into the news headlines, such as:

  • A 20-year-old woman in Detroit was declared dead after 30 minutes of CPR. She was taken to the funeral home where staff discovered she was breathing. She was treated in the hospital, but died 2 months later.
  • A 23-year-old British man was pronounced dead after failed CPR. About 30 minutes later, a priest gave him last rites and noticed he was breathing. He died in the hospital 2 days later.
  • In Ohio, a 37-year-old man collapsed at home. In the hospital, his heart stopped, and he was pronounced dead despite 45 minutes of CPR. Several minutes later, his family noticed his monitor showed a heart rhythm. A week later, he was well enough to go home.

Get Matched With A Leading Birth Injurycerebral Palsy Attorney In Your Area

An acquired brain injury occurs when something happens internally, inside the skull or brain.

During childbirth, nearly half of all brain damage is caused by asphyxiation, when the brain is deprived of oxygen. This can occur because of an illness in the mother, when there are complications with the umbilical cord or placenta, or when the babys head becomes stuck in the birth canal.

In some cases, the causes of brain damage are unforeseen. They may be accidents that could not be prevented.

However, there are also preventable accidents that are the result of a medical caregivers negligence. In these instances, parents can consider filing a medical malpractice lawsuit against the negligent party.

For example, if a doctor fails to recognize complications and to call for a Cesarean section, a resulting birth injury could possibly be considered medical malpractice.

Other possible medical malpractice scenarios include a doctor misusing forceps, failure to properly diagnose, or failure to monitor for fetal or maternal stress.

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Causes Of Brain Oxygen Deprivation

There are certain health conditions and incidents that disturb the supply of oxygen to the brain. These situations could take place at your work due to toxic work environment. It could also occur because of someones irresponsible behaviour on the road or at public place. Some of them are cardiac attack, heart stroke and unusual heartbeat which could impede the path of oxygen from heart to brain. There are many other causes listed below that could lead the situation of oxygen deprivation:

Chocking breathing in fumes or munching or drinking too quickly Hypotension when you have way too low blood pressure Anesthesia related problems during surgical treatment Drowning you are way too long under the water and loose the track of breathing Carbon monoxide poisoning blocks the bloodstream Fire in the building tons of smoke makes it difficult to breathe Strangulation the neck is compressed and does not allow the oxygen flow Complications from anesthesia trauma that causes blood loss Asthma attack medical condition makes it hard to breathe or Tracking or travelling height above the sea level typically more than 8000 ft.

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