Abstract Details

Title Brain Dead or Alive: Pitfalls in Neurological Prognostication

Topic Practice, Policy, and Ethics

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 1-002

Background The Uniform Determination of Death Act (UDDA) of 1981 defined the legal standard for death by neurologic criteria but neglected to specify medical standards for determination. Although numerous algorithms exist to ascertain the diagnosis of brain death, these criteria remain inconsistent and frequently open to interpretation. Such limitations have led to calls to revise and legally standardize the UDDA.

Objective To highlight the need for supplemental testing to determine brain death, should the diagnosis be unclear.

Design/Methods N/A

Results We describe a 32 year old male with a past medical history of SLE who originally presented to an outside hospital after a cardiac arrest while jogging. The patient was successfully resuscitated in the field. His EKG showed changes indicative of anteriolateral wall myocardial infarction. His EEG showed abnormal contour in the posterior fields, prompting treatment with levetiracetam. Despite a normal brain MRI, the treating neurological team diagnosed the patient with anoxic brain injury given his persistently comatose exam and abnormal EEG. With an anticipated poor neurological prognosis, the patient’s family elected for a terminal extubation and organ donation. He survived the terminal extubation and was transferred to our hospital for neurological prognostication. Upon arrival, EEG showed lateralized periodic discharges, prompting an increase in levetiracetam and adding clobazam. He was also treated for multiple infections. After optimization of his regimen, his EEG normalized and he became more alert and interactive. He was discharged to TBI rehabilitation with follow-up, where he was able participate fully in the physical exam.

Conclusions The lack of uniformity when approaching comatose patients with presumed irreversible neurologic injury can lead to inaccurate prognostication and guide life-or-death clinical decisions. This case of erroneous assessment highlights the marked limitations of the current legal framework for determining brain death under the UDDA and the need for standardized medical criteria.

Authors/Disclosures
Danielle Bazer, DO (Johns Hopkins) PRESENTER	Dr. Bazer has received research support from Keep Punching.
Matthew Orwitz, MD	Dr. Orwitz has nothing to disclose.
Nicholas Koroneos, DO (Mcleod Seacoast Neurology)	Dr. Koroneos has nothing to disclose.
Ryan C. Corn, DO (Stony Brook University Hospital, SUNY Stony Brook)	Dr. Corn has nothing to disclose.
Philip Yeung, MD (Northwell Manhasset)	Dr. Yeung has nothing to disclose.
	No disclosure on file