[Studies on evaluation of brain death].
OBJECTIVE
To investigate the methods of evaluating brain death accurately and objectively.


METHODS
Various kinds of clinical examination [including conscious state, Glasgow coma score (GCS), brain stem reflection, cranial nerve dominated actions, spinal reflection, spinal nerve dominated automatic action, respiratory and apnea testing] and laboratory methods [such as electroencephalography (EEG), brainstem auditory evoked potentral (BAEP), brainstem auditory sensery evoked potentral (SLSEP) and transeranial Doppler (TCD)] were used to evaluate 11 cases with brain death.


RESULTS
Eleven cases presenting with deep coma were conssedered to have brain death. All of them had GCS score of 3 and disappearance of brain stem reflection and cranial nerve dominated automatic action. Six of them patients showed anisocoria. Nine of them pharyngeal reflex could not be detected because of tracheal cannulization, but this did not influence the evaluation of brain death. None of them showed "flat" EEG and disappearience of BAEP dominant wave. None of the SLSEP show any wave behind N13. TCD showed blood stream characteristic of brain death except in one case blood stream characteristic of increased intracraniai pressure. Apnea test and atropine test provided the final proof brain death. The former had more influence on heart rate, blood pressure and oxygen saturation while the latter were more safe and reliable.


CONCLUSIONS
Combined and continuous observation of clinical and laboratory indices can enhance the accuracy of the evaluation of brain death.
Su
Ying-ying
YY
Department of Neurology, Xuanwu Hospital, Capital University of Medical Sciences, Beijing 100053, China. tangsuyinyin@yahoo.com.cn
Zhao
Hong
H
Zhang
Yan
Y
Wang
Xiao-mei
XM
Hua
Yang
Y
D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D001926:Brain Death / Q000175:diagnosis*; D020520:Brain Infarction / Q000175:diagnosis; D002681:China; D003422:Critical Care; D004569:Electroencephalography; D016057:Evoked Potentials, Auditory, Brain Stem; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017585:Ultrasonography, Doppler, Transcranial