1/12. Ethical perspectives in neuroscience nursing practice.The role of neuroscience nurses in relation to ethical issues has become increasingly complex. knowledge of ethical principles and theories assists the nurse in the development of a theoretical basis for resolution of ethical issues or concerns. Additionally, the nurse must possess information regarding practice codes or standards as well as legislative requirements. The nurse must act as an advocate for the patient and society through active participation in institutional ethics committees and legislative forums.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/12. Confounding factors in diagnosing brain death: a case report.BACKGROUND: brain death is strictly defined medically and legally. This diagnosis depends on three cardinal neurological features: coma, absent brainstem reflexes, and apnea. The diagnosis can only be made, however, in the absence of intoxication, hypothermia, or certain medical illnesses. CASE PRESENTATION: A patient with severe hypoxic-ischemic brain injury met the three cardinal neurological features of brain death but concurrent profound hypothyroidism precluded the diagnosis. Our clinical and ethical decisions were further challenged by another facet of this complex case. Although her brain damage indicated a hopeless prognosis, we could not discontinue care based on futility because the only known surrogate was mentally retarded and unable to participate in medical planning. CONCLUSION: The presence of certain medical conditions prohibits a diagnosis of brain death, which is a medicolegal diagnosis of death, not a prediction or forecast of future outcome. While prognostication is important in deciding to withdraw care, it is not a component in diagnosing brain death.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
3/12. Improving oxygenation when conventional ventilation fails: a case study.Long periods of significant hypoxia do not disqualify a patient from becoming an organ donor. As the management of organ donor patients becomes more complex, recovery coordinators often have to change their thinking and resort to nonconventional means of management. This case study presents a hypoxic donor and how using pressure-control inverse ratio ventilation improved oxygenation in this donor. Before changing ventilator modes, the transplant surgeons were concerned about the long periods of hypoxia the patient had experienced during her hospitalization. After making the change, improving oxygenation, and demonstrating an improved oxygen state, 4 organs were recovered and subsequently transplanted. All the recovered organs functioned immediately after transplantation without any signs of poor performance. Although this treatment modality is not available at every institution, it can be used to improve oxygenation problems in organ donors.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
4/12. Complex spinal reflexes during transcranial Doppler ultrasound examination for the confirmation of brain death.OBJECTIVE: Complex sets of movements of the extremities can be seen in patients with brain death (BD), and are typically observed during apnea testing or removal of ventilatory support (also called the Lazarus sign). We here describe brain-dead patients who had not shown previous movements, even during apnea testing, but presented complex spinal reflexes during transcranial Doppler (TCD) examination elicited by neck flexion. methods: We performed a prospective TCD study of patients with the clinical diagnosis of BD. RESULTS: Four (2.5%) of 161 brain-dead patients presented complex spinal reflexes exclusively during TCD examination. TCD showed vertebro-basilar circulatory arrest in all four. Their systolic blood pressure was significantly lower than that of brain-dead patients not presenting movements during TCD examination. CONCLUSIONS: hypotension and mechanical stimulation play a role in the pathophysiology of complex spinal reflexes present in BD, which are not exclusively seen in terminal hypoxia. intensive care personnel and neurologists who perform TCD to confirm BD should be aware of these movements.- - - - - - - - - - ranking = 3keywords = complex (Clic here for more details about this article) |
5/12. The undulating toe flexion sign in brain death.Brain-dead patients may exhibit gross spontaneous and reflex movements (e.g., Babinski sign, stereotypic flexion of one or more limbs, and Lazarus sign). We report three brain-dead patients who had unusual complex sequential movements of the toes. Undulating toe flexion was elicited by noxious stimuli to the lower extremities, and consisted of initial plantar flexion of the great toe, followed by sequential brief plantar flexion of the second, third, fourth, and fifth toes. The undulating toe flexion sign differs from previously described responses characterized by plantar flexion of the toes (e.g., Rosselimo's sign and the Mendel-Bechterew sign) in that it consists of complex patterned sequential movements of the digits rather than brief simultaneous flexion and/or fanning of the toes. Neurologists should be aware of this unusual finding, which should not preclude the diagnosis of brain death.- - - - - - - - - - ranking = 2keywords = complex (Clic here for more details about this article) |
6/12. Maternal brain death: medical, ethical and legal issues.CASE PRESENTATION: We present the case of a pregnant woman who experienced a cerebral venous sinus thrombosis resulting in brain death at 13 weeks gestation. We discuss the management of the mother and foetus following this tragic event. We also discuss the complex medical, legal and ethical issues that arose following maternal brain death. The central question is whether continuing maternal organ supportive measures in an attempt to prolong gestation to attain foetal viability is appropriate, or whether it constitutes futile care. DISCUSSION: Successful maintenance of maternal brain somatic function to facilitate foetal maturation in utero has been reported. While the gestational age of the foetus is central to resolving this issue, there is no clear upper physiological limit to the prolongation of somatic function following brain death. Furthermore, medical experience regarding prolonged somatic support is limited. Finally, the legal rights conferred on the foetus may vary significantly depending on the jurisdiction in which the maternal brain death occurs and may have important implications. CONCLUSIONS: A consensus building approach, involving the family, is essential to resolving these potentially conflicting issues.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
7/12. Preserved spinal dorsal horn potentials in a brain-dead patient with Lazarus' sign. Case report.The case of a brain-dead patient with complex movements of the extremities (Lazarus' sign) is reported. This is the first description in the literature of short-latency somatosensory evoked potentials (SSEP's) following median-nerve stimulation by a noncephalic reference method. The scalp P14 wave (a far-field positivity with a peak latency around 14 msec that originates from the cervicomedullary junction) disappeared, and the spinal N13 wave (a near-field negativity with a 13-msec peak recorded on the posterior neck and generated by the cervical dorsal horn) was preserved. Respiratory-like movement was also seen in this case. The SSEP. findings support the hypothesis that both Lazarus' sign and respiratory-like movement have a spinal origin.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
8/12. Sudden traumatic death in children: "we did everything, but your child didn't survive".When caring for children who become suddenly and catastrophically ill, clinicians must simultaneously attend to a complex and rapidly evolving medical situation, as well as to the equally challenging demands of establishing compassionate relationships with family members and communicating well with colleagues. An 18-month-old toddler was brought to the hospital with severe head injury after being struck by a car. Over a period of hours, her condition evolved from prognostic uncertainty to the diagnosis of brain death and considerations of organ donation. Against this medical backdrop, the clinicians successfully established a trusting relationship with family members by careful attention to their emotional, informational, and care needs as they absorbed the devastating prognosis, took in the results of the brain death examination, and considered the option of organ donation. This case illustrates the importance of interdisciplinary communication, the vital role of social workers and other psychosocial providers with expertise in working with families, and the critical significance of mutual care and support for the clinicians who accompany families through these tragic life events.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
9/12. Neocortical death in infants: behavioral, neurologic, and electroencephalographic characteristics.Neocortical death is a form of the persistent vegetative state characterized by the maintenance of sleep/wakeful cycles and spontaneous respirations and the lack of cognitive function. It is difficult to diagnose in neonates and young infants because their cognitive skills are limited by inexperience and by immaturity of the central nervous system. Because neocortical death has not been described previously for this age group, we report the neurologic, behavioral, electroencephalographic, and computed tomographic characteristics of three infants who survived in the persistent vegetative state following severe brain injury. Each infant appeared to exhibit some complex behaviors, including interaction with the environment and the examiners, although the electroencephalograms documented no electrical activity of cerebral origin. Computed tomography revealed extensive destruction of the cerebral hemispheres. Infants and newborns with a history suggesting brain injury and with the neurologic and behavioral characteristics described here should be evaluated with serial electroencephalograms and computed tomography to diagnose the syndrome of neocortical death.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
10/12. Uncommon extensive juxtacortical necrosis of the brain.A previously healthy woman in middle age, vacationing in spain, is treated with a massive dose of insulin for minimal hyperglycemia following an apparent gastrointestinal disease. This results in rapid coma and, 20 days later, in death. At autopsy, the main finding consists in a remarkable and uncommon ribbon-like juxtacortical necrosis of the white matter in both hemispheres of the telencephalon. There is also a microscopic focal necrosis in the pons cerebri. The grey matter of cortex and basal nuclei, and the subcortical arcuate fibers are spared. The detailed autopsy fails to reveal other essential changes. We have not been able to find reports on an identical case. Hypoglycemic coma usually causes cerebral lesions different from those seen in the present case. A brief analysis of the differential diagnosis is made. In the absence of unequivocal signs of infection, vascular disease or degenerative marks, the findings are tentatively related to complex interactions between fluid loss, hypoglycemic coma, hypoxia and other metabolic disturbances.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
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