Cases reported "Brain Death"

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1/184. Auditory brain-stem responses in brain death.

    Auditory brain-stem responses were measured by far-field recording techniques in 27 patients fulfilling the criteria of brain death. The responses were either absent or consisted of the presence of just the initial component (Wave I). Wave I, when present, was of normal amplitude but prolonged in latency. Four patients were followed over several days from a state of coma with evidence of preserved brain-stem and cerebral functions to a clinical state compatible with brain death. Auditory brain-stem responses were initially intact and then showed a decrease in amplitude and a prolongation of latency of the later components until finally Wave I was alone. Auditory brain-stem responses are an objective measure of one of the sensory pathways traversing the brain-stem and can be used to evaluate the functional states of the brain-stem in patients in whom the question of brain death has been raised.
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2/184. A matter of life and death: what every anesthesiologist should know about the medical, legal, and ethical aspects of declaring brain death.

    Accurate criteria for death are increasingly important as it becomes more difficult for the public to distinguish between patients who are still alive from those who, through the aid of medical technology, merely look like they are alive even though they are dead. patients and their families need to know that a clear line can be drawn between life and death, and that patients who are alive will not be unintentionally treated as though they are dead. For the public to trust the pronouncements of medical doctors as to whether a patient is dead or alive, the criteria must be unambiguous, understandable, and infallible. It is equally important to physicians that accurate, infallible criteria define death. physicians need to know that a clear line can be drawn between life and death so that patients who are dead are not treated as though they are alive. Such criteria enable us to terminate expensive medical care to corpses. Clear criteria for death also allow us to ethically request the gift of vital organs. Clear, infallible criteria allow us to assure families and society that one living person will not be intentionally or unintentionally killed for the sake of another. The pressure of organ scarcity must not lead physicians to allow the criteria for life and death to become blurred because of the irreparable harm this would cause to the patient-physician relationship and the devastating impact it could have on organ transplantation. As the cases presented here illustrate, anesthesiologists have an important responsibility in the process of assuring that some living patients are not sacrificed to benefit others. Criteria for declaring death should be familiar to every anesthesiologist participating in organ retrieval. Before accepting the responsibility of maintaining a donor for vital organ collection, the anesthesiologist should review data supplied in the chart supporting the diagnosis of brain death and seriously question inconsistencies and inadequate testing conditions. knowledge of brain death criteria and proper application of these criteria could have changed the course of each of the cases presented.
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3/184. Fetal brain death and Dandy-Walker malformation.

    The diagnosis of brain death by Doppler ultrasonography and magnetic resonance imaging is reported in a fetus at 23 weeks' gestation. This is believed to be the first instance in which brain death has been shown in a premature fetus with a brain-stem anomaly.
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4/184. Cerebral arteriovenous malformation in pregnancy: presentation and neurologic, obstetric, and ethical significance.

    Cerebral arteriovenous malformations infrequently complicate pregnancy. We sought to determine the neurologic, obstetric, and ethical significance of such malformations. We present the clinical course of 2 pregnant women with arteriovenous malformations who experienced cerebral hemorrhage and a loss of capacity for decision making. We also review the neurologic and obstetric significance of arteriovenous malformations in pregnancy. Various treatment options with concern for pregnancy and the prognosis for arteriovenous malformations are outlined. The ethical issues involved for pregnant patients whose decisional capacity is compromised as a result of cerebral injury are explored. A review of persistent vegetative state and brain death (death by neurologic criteria) occurring in pregnancy allows us to explore many issues that are applicable to decisionally incapacitated but physiologically functioning pregnant women. We outline a document, the purpose of which is to obtain advance directives from pregnant women regarding end-of-life decisions and to appoint a surrogate decision maker. We believe that evaluation and treatment of the arteriovenous malformation may be undertaken without regard for the pregnancy and that the pregnancy should progress without concern for the arteriovenous malformation.
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keywords = death
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5/184. Diagnosing death: What's trust got to do with it?

    physicians licensed to practice medicine have enjoyed socially endorsed, legally underwritten status-trust to a remarkable degree. However, such trust is not endorsed equally by all segments of American society, most notably, by african americans. Because physicians underappreciate this fact, they fail to understand how routine medical behavior can disproportionately exacerbate african americans' pre-existing suspicions. On the other hand, overinterpretation of this fact needlessly risks despair. A theory of trust provides guidance in resolving clinical conflicts.
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keywords = death
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6/184. Familial fatal and near-fatal third ventricle colloid cysts.

    BACKGROUND: Despite having a presumed congenital origin, familial cases of colloid cysts have been reported only rarely. The first case of a brother and sister with colloid cysts is reported here, and the relevant literature is reviewed. methods: A 25-year-old man presented with a 24-h history of headache and vomiting. He rapidly became unconscious and fulfilled the criteria for brain death on arrival at hospital. No surgical intervention was performed. RESULTS: The patient's sister presented at the age of 41 with headaches and rapidly became unconscious. The sister had urgent bilateral ventriculostomies. followed by transcallosal removal of a colloid cyst. CONCLUSIONS: These cases support the hypothesis that colloid cysts are congenital lesions and provide some evidence of a possible genetic predisposition to their formation. Sudden death remains a real risk for patients harbouring a colloid cyst.
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7/184. First brain dead donor heart transplantation under new legislation in japan.

    The first heart transplantation was carried out in japan successfully, after the brain death and organ transplantation law was settled in 1997. The recipient patient was a 47-year-old man with the dilated phase of hypertrophic cardiomyopathy who had been on a Novacor implantable left ventricular assist system for the previous 4 months. Since the donor hospital was about 200 km from the recipient hospital which took approximately 2 hours for transportation, the total ischemic time was 3 hours and 24 minutes. The post-transplant course was smooth, and the patient was discharged on postoperative day 75.
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ranking = 0.14285714285714
keywords = death
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8/184. diffusion-weighted magnetic resonance imaging in brain death.

    BACKGROUND; Traditionally the diagnosis of brain death is established on the basis of a combination of clinical signs and paraclinical methods. diffusion-weighted MRI is a new method sensitive to cerebral ischemia. Its value in brain death has not been demonstrated until now. CASE DESCRIPTION: A patient was referred to MRI with suspicion of a brain stem stroke. Echo-planar whole-brain, multislice, diffusion-weighted MRI was performed in addition to conventional sequences and MR angiography sequences. In addition to the extensive bilateral hyperintensities observed on T2-weighted images, diffusion-weighted MRI showed diffuse hyperintensities involving both hemispheres as well as a severe drop in the apparent diffusion coefficient in both affected hemispheres. There was also transtentorial herniation with compression of the brain stem as well as absence of flow voids on the T2-weighted images and absence of intracranial vessels on MR angiography. On the basis of the clinical and imaging findings, it was concluded that the patient was in a state of brain death. The patient died the same day. CONCLUSIONS: With the use of new fast techniques such as diffusion-weighted imaging, now MRI can not only display anatomic changes associated with severe brain suffering but can also demonstrate ultrastructural changes secondary to brain death and differentiate them from edematous changes seen on T2-weighted images.
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ranking = 1.1428571428571
keywords = death
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9/184. Reversible left ventricular dysfunction associated with raised troponin i after subarachnoid haemorrhage does not preclude successful heart transplantation.

    Transient abnormalities in ECGs, echocardiograms, and cardiac enzymes have been described in the acute setting of subarachnoid haemorrhage. In addition, left ventricular dysfunction has been reported at the time of brain death. A patient with an acute subarachnoid haemorrhage who presented with raised troponin i (TnI) concentrations and diffuse left ventricular dysfunction is described. After declaration of brain death 32 hours later, the heart was felt initially not suitable for transplantation. A normal cardiac catheterisation, however, lead to successful transplantation of the donor heart. Raised catecholamine concentrations and metabolic perturbations have been proposed as the mechanisms leading to the cardiac dysfunction seen with brain death. This may be a biphasic process, allowing time for myocardial recovery and reversal of the left ventricular dysfunction. awareness of this phenomenon in the acutely ill neurologic population needs to be raised in order to prevent the unnecessary rejection of donor hearts.
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ranking = 0.42857142857143
keywords = death
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10/184. Brainstem death and ventilator trigger settings.

    A patient with cerebral infarction was certified clinically brainstem dead. However, 4 h after the diagnosis of death, while the patient was being ventilated using the biphasic positive airway pressure mode, the 'assist' indicator light on the Drager Evita 2 ventilator illuminated intermittently. There was no evidence of spontaneous breathing. 'Triggering' was probably caused by a decrease in airway pressure in time with cardiac contraction. The trigger flow rate is crucial as factors other than the patient's inspiratory effort can initiate flow from the ventilator with very sensitive settings.
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ranking = 0.71428571428571
keywords = death
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