title: Factors Affecting the Occurrence of Spinal Reflexes in Brain Dead Cases.
abstract: OBJECTIVE
  Brain death is defined as the permanent absence of all cortical and brain stem reflexes. A wide range of spontaneous or reflex movements that are considered medullary reflexes are observed in heart beating cases that appear brain dead, which may create uncertainty about the diagnosis of brain death and cause delays in deceased-donor organ donation process. We determined the frequency and type of medullary reflexes and factors affecting their occurrence in brain dead cases.
  
  
  METHODS
  During 1 year, 122 cases who fulfilled the criteria for brain death were admitted to the special intensive care unit for organ procurement of Masih Daneshvari Hospital. Presence of spinal reflexes was evaluated by trained coordinators and was recorded in a form in addition to other information including demographic characteristics, cause of brain death, time from detection of brain death, history of craniotomy, vital signs, serum electrolyte levels, and parameters of arterial blood gas determination.
  
  
  RESULTS
  Most cases (63%) included in this study were male, and mean age was 33 ± 15 y. There was > 1 spinal reflex observed in 40 cases (33%). The most frequent reflex was plantar response (17%) following by myoclonus (10%), triple flexion reflex (9%), pronator extension reflex (8%), and undulating toe reflex (7%). Mean systolic blood pressure was significantly higher in cases who exhibited medullary reflexes than other cases (126 ± 19 mm Hg vs 116 ± 17 mm Hg; P = .007).
  
  
  CONCLUSIONS
  Spinal reflexes occur frequently in brain dead cases, especially when they become hemodynamically stable after treatment in the organ procurement unit. Observing these movements by caregivers and family members has a negative effect on obtaining family consent and organ donation. Increasing awareness about spinal reflexes is necessary to avoid suspicion about the brain death diagnosis and delays in organ donation.
authors: Telemedicine Research Center, Ministry of Health, San'at Square, Tehran, Iran.
authors: Mahsa Sadat
authors: MS
authors: Hosseini
authors: Fariba
authors: F
authors: Ghorbani
authors: Omid
authors: O
authors: Ghobadi
authors: Katayoun
authors: K
authors: Najafizadeh
mesh_terms: D000293:Adolescent; D000328:Adult; D001926:Brain Death / Q000503:physiopathology*; D001933:Brain Stem / Q000503:physiopathology*; D002423:Cause of Death; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D009068:Movement; D009119:Muscle Contraction; D009460:Neurologic Examination; D012018:Reflex; D013127:Spinal Nerves / Q000503:physiopathology*; D055815:Young Adult