Many brain-dead patients have spontaneous movements such as jerking of fingers or bending of toes that can be disturbing to family members and health care professionals and even cause them to question the brain-death diagnosis.
A variety of reflex movements have been reported in patients with brain death, such as plantar responses, muscle stretch reflexes, abdominal reflexes, and finger jerks (2). Because the aforementioned reflexes are spinal reflexes, the existence of such reflex movements does not preclude the diagnosis of brain death.
Occasionally, a person's limbs or torso (the upper part of the body) may move, even after brain stem death has been diagnosed. These spinal reflex movements are generated by the spinal cord and don't involve the brain at all.
They do not hear or feel anything, including pain. This is because the parts of the brain that feel, sense, and respond to the world no longer work. In addition, the brain can no longer tell the body to breathe. Because the brain cannot control breathing, breathing must be done by a machine, called a ventilator.
These movements were observed mainly within the first 24 hours after declaration of brain death and consisted of spontaneous jerks of the fingers, undulating toe flexion, triple flexion, unilateral facial myokymia, "Lazarus sign," upper limb pronation/extension reflex, and flexor plantar response.
Article abstract-Striking arm movements are described in five brain- dead patients. The arms flex quickly to the chest from the patient's side, the shoulders adduct, and in some patients, the hands cross or oppose just below the chin. The limbs then return to the patient's side, sometimes asym- metrically.
Tremor and dystonia are the most reported movement disorders following traumatic brain injury. Dystonia and myoclonus are well documented following hypoxic ischemic brain injuries.
Variability in the diagnosis of brain death has the potential to lead to misdiagnosis. Even in the clearest circumstances, families may have difficulty accepting a diagnosis of brain death when they see their loved one's heart still beating and feel their body warm to the touch.
But without a ventilator to keep blood and oxygen moving, this beating would stop very quickly, usually in less than an hour, Greene-Chandos said. With just a ventilator, some biological processes — including kidney and gastric functions — can continue for about a week, Greene-Chandos said.
Agonal breathing or agonal gasps are the last reflexes of the dying brain. They are generally viewed as a sign of death, and can happen after the heart has stopped beating.
For a diagnosis of brain death: a person must be unconscious and fail to respond to outside stimulation. a person's heartbeat and breathing can only be maintained using a ventilator. there must be clear evidence that serious brain damage has occurred and it cannot be cured.
Brain death is death. A patient who is in a coma or persistent vegetative state typically has some brain stem function (which controls breathing) and possibly other brain function. When a person is brain dead, no part of the brain is functioning any longer.
A persistent vegetative state means the person has lost higher brain functions, but their undamaged brain stem still allows essential functions like heart rate and respiration to continue. A person in a vegetative state is alive and may recover to some degree, given time.
In time, the heart stops and they stop breathing. Within a few minutes, their brain stops functioning entirely and their skin starts to cool. At this point, they have died.
That means the patient wouldn`t be able to cough, swallow or breathe on their own, whereas a patient in a vegetative state might be able to do one or all of those three things, DiGeorgia said. “You unplug the plug when the person has no brain waves and no hope of quality of life,” Braverman said.
Increased intracranial pressure (ICP) is considered the most important pathophysiological mechanism of BD leading to a complete cessation of intracranial blood flow.
Within hours, blood is pulled downwards, causing splotches on the skin. Because the heart is no longer pumping blood around the body, it starts being pulled down by gravity. As the blood pools, patches appear on the skin within 30 minutes of death.
The human brain rapidly dissolves after death due to the break down of proteins and putrefaction. Decomposition often occurs within minutes after death, which is quicker than other body tissues, likely because the brain is about 80% water.
The UDDA in combination with the DDR assures patients, families, physicians, and other health professionals that a patient who is brain dead is in fact dead, making removal of organs for life-saving transplantation legally and ethically acceptable.
It is possible to have a brain injury without having symptoms, but they may surface weeks later. The patient may suddenly experience headaches or dizziness, and it is possible not to remember having the injury. The patient may also have mental health symptoms such as depression or anxiety. Or be more fatigued.
After the first clinical exam, the patient should be observed for a defined period of time for clinical manifestations that are inconsistent with the diagnosis of brain death. Most experts agree that a 6 hour observation period is sufficient and reasonable in adults and children over the age of 1 year.
In the British studies, it was estimated that up to 40% of patients are misdiagnosed as being “brain dead” when in fact they had varying levels of consciousness. Individuals who are comatose do not respond to light or pain, and do not have a normal sleep-wake cycle.
Causes of a Clenched Hand & Curled Fingers After Stroke
When a stroke damages areas of the brain that control hand function, such as the motor cortex, it disrupts that communication between the hand and nervous system. As a result, the hand muscles will contract involuntarily, or spasm.
Reflex and spontaneous movements are not uncommon during the process of determining brain death. The frequency of such movements ranges from 19.2%–75% among all brain dead cases but the reported frequencies widely vary from one study to another.
Cerebellum. The cerebellum is located at the back of the brain beneath the occipital lobes. It is separated from the cerebrum by the tentorium (fold of dura). The cerebellum fine tunes motor activity or movement, e.g. the fine movements of fingers as they perform surgery or paint a picture.