Skip to main content
SpringerLink
Log in

Coma and Brain Death

  • Chapter
  • First Online:
Neurointensive Care Unit

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

Disorders of consciousness are routinely seen in the neurocritical care unit (NCCU). This chapter reviews the neuroanatomical basis for coma, followed by a detailed discussion of the common differential diagnoses, including cerebrovascular, epileptiform, traumatic, infectious, toxic, and metabolic etiologies. Practical guidance regarding examination and management follows. Brain death is discussed in detail. Practical steps in preparing patients for and proceeding with the determination of brain death are reviewed. Guidance is provided for discussing brain death with families and preparing for organ donation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

Coma Definition References

  1. Ropper AH, Klein J, Samuels MA. Adams and Victor’s principles of neurology. 10th ed. New York: McGraw Hill Medical; 2014.

    Google Scholar 

  2. Jennet B, Plum F. Persistent vegetative state after brain damage: a syndrome in search of a name. Lancet. 1972;299(7753):734–7.

    Article  Google Scholar 

  3. Jennet B. Chapter 1: a syndrome in search of a name. In: Jennet B, editor. The vegetative state: medical facts, ethical and legal dilemmas. Cambridge: Cambridge University Press; 2002. p. 1–10.

    Chapter  Google Scholar 

  4. Gosseries O, et al. Chapter 2: disorders of consciousness: coma, vegetative and minimally conscious states. In: Cvetkovic D, Cosic I, editors. States of consciousness: experimental. Insights into meditation, waking, sleep and dreams. New York: Springer; 2011. p. 29–55.

    Chapter  Google Scholar 

  5. Monti MM, Vanhaudenhuyse A, Coleman MR, et al. Willful modulation of brain activity in disorders of consciousness. N Engl J Med. 2010;362:579–89.

    Article  CAS  PubMed  Google Scholar 

  6. Piperno R, Battistini A, Cevolani D, Maffei M, et al. FMRI activation with an “affective speech” paradigm in vegetative and minimally conscious states: applicability and prognostic value. Neuroradiol J. 2012;25:289–99.

    Article  CAS  PubMed  Google Scholar 

  7. Owen AM, Coleman MR. Detecting awareness in the vegetative state. Ann N Y Acad Sci. 2008;129:130–8.

    Article  Google Scholar 

  8. Giacino JT Ashwal S, Childs N, Cranford R, et al. The minimally conscious state: definition and diagnostic criteria. Neurology. 2002;58(3):349–53.

    Article  PubMed  Google Scholar 

  9. Giacino JT, Kalmar K. The vegetative and minimally conscious states: a comparison of clinical features and functional outcome. J Head Trauma Rehabil. 1997;12:36–51.

    Article  Google Scholar 

  10. Luaute J, Maucort-Boulch D, Tell L, Quelard F, et al. Long-term outcomes of chronic minimally conscious and vegetative states. Neurology. 2010;75(3):246–52.

    Article  CAS  PubMed  Google Scholar 

  11. Moruzzi G, Magoun HW. Brain stem reticular formation and activation of the EEG. Electroencephalogr Clin Neurophys. 1949;1:455.

    Article  CAS  Google Scholar 

  12. Plum F, Posner JB. Diagnosis of stupor and coma. 4th ed. Philadelphia: Oxford University Press; 2007.

    Google Scholar 

Cerebrovascular Injury References

  1. Caplan L. Top of the basilar syndrome. Neurology. 1980;30:72–9.

    Article  CAS  PubMed  Google Scholar 

  2. Honig A, Eliahou R, Eichel R, et al. Acute bithalamic infarct manifesting as sleep-like coma: a diagnostic challenge. J Clin Neurosci. 2016;34:81–5.

    Article  PubMed  Google Scholar 

  3. Arauz A, Patino-Rodriguez HM, Vargas-Gonzalez JC, et al. Clinical spectrum of artery of Percheron infarct: clinical-radiological correlations. J Stroke Cerebrovasc Dis. 2014;23(5):1083–8.

    Article  PubMed  Google Scholar 

  4. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–7.

    Article  Google Scholar 

  5. Hacke W, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317–29.

    Article  CAS  PubMed  Google Scholar 

  6. Badhiwala JH, Nassiri F, Alhazzani W, Selim MH, et al. Endovascular thrombectomy for acute ischemic stroke: a Meta- analysis. JAMA. 2015;314(17):1832–43.

    Article  CAS  PubMed  Google Scholar 

  7. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11–21.

    Article  PubMed  Google Scholar 

  8. Torbey MT, Bosel J, Rhoney DH, Rincon F, et al. Evidence-based guidelines for the Management of Large Hemispheric Infarction: a statement for health care professionals from the Neurocritical care society and the German Society for Neuro-Intensive Care and Emergency Medicine. Neurocrit Care. 2015;22:146–64.

    Article  PubMed  Google Scholar 

  9. Hemphill JC, Greenberg SM, Anderson CS, Becker K, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032–60.

    Article  PubMed  Google Scholar 

  10. Mendelow AD, Gregson BA, Rowan EN, Murray GD, et al. Early versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematoma (STICH II): a randomised trial. Lancet. 2013;382(9890):397–408.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Herrick DB, Ullman N, Nekoovaght-Tak S, Hanley DF, et al. Determinants of external ventricular drain placement and associated outcomes in patients with spontaneous intraventricular hemorrhage. Neurocrit Care. 2014;21:426–34.

    Article  PubMed  Google Scholar 

  12. Lantigua H, Ortega-Gutierrez S, Schmidt JM, Lee K, et al. Subarachnoid hemorrhage: who dies, and why. Crit Care. 2015;19:309.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ransom ER, Mocco J, Komotar RJ, Sahni D, et al. External ventricular drainage response in poor grade aneurysmal subarachnoid hemorrhage: effect on preoperative grading and prognosis. Neurocrit Care. 2007;6:174–80.

    Article  PubMed  Google Scholar 

  14. Diringer MN, Bleck TP, Hemphill JC, Menon D, et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical care Society’s multidisciplinary consensus conference. Neurocrit Care. 2011;15:211–40.

    Article  PubMed  Google Scholar 

Electrographic References

  1. DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996;46(4):1029–35.

    Article  CAS  PubMed  Google Scholar 

  2. Oddo M, Carrera E, Claassen J, et al. Continuous electroencephalography in the medical intensive care unit. Crit Care Med. 2009;37:2051–6.

    Article  PubMed  Google Scholar 

  3. Kurtz P, Gaspard N, Wahl AS, et al. Continuous electroencephalography in a surgical intensive care unit. Intensive Care Med. 2014;40(2):228–34.

    Article  PubMed  Google Scholar 

  4. Claasen J, Mayer SA, Kowalski RG, Emerson RG, et al. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62:1743–8.

    Article  Google Scholar 

  5. Claasen J, Taccone FS, Horn P, Holtkamp M, et al. Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Med. 2013;39:1337–51.

    Article  CAS  Google Scholar 

  6. Cheng JY. Latency to treatment of status epilepticus is associated with mortality and functional status. J Neurol Sci. 2016;370:290–5.

    Article  PubMed  Google Scholar 

  7. Treiman DM, Meyers PD, Walton NY, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans affairs status Epilepticus cooperative study group. N Engl J Med. 1998;339:792–8.

    Article  CAS  PubMed  Google Scholar 

  8. Silbergleit R, Durkalski V, Lowenstein D, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med. 2012;366(7):591–600.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Bleck TP, Cock H, Chamberlain J, Cloyd J, et al. The established status epilepticus trial 2013. Epilepsia. 2013;54(Suppl 6):89–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Brophy GM, Bell R, Claasen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3–23.

    Article  PubMed  Google Scholar 

Hypoxic/Ischemic Injury References

  1. Dhakal LP, Sen A, Stanko CM, Rawal B, et al. Early absent pupillary light reflexes after cardiac arrest in patients treated with therapeutic hypothermia. Ther Hypothermia Temp Manag. 2016;6(3):116–21.

    Article  PubMed  Google Scholar 

  2. Geocadin RG, Wijdicks E, Armstrong MJ, Damian M, et al. Practice guideline summary: reducing brain injury following cardiopulmonary resuscitation: report of the guideline development, dissemination, and implementation Subcommitte of the American Academy of Neurology. Neurology. 2017;88(22):2141–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Callaway CW, Donnino MW, Fink EL, Geocadin RG, et al. Part 8: post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 suppl 2):S462–82.

    Article  Google Scholar 

  4. Mani R, Schmitt SE, Mazer M, Putt ME, et al. The frequency and timing of epileptiform activity on continuous electroencephalogram in comatose post-cardiac arrest syndrome patients treated with therapeutic hypothermia. Resuscitation. 2012;83:840–7.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Backman S, Westhall E, Dragancea I, Friberg H, et al. Electroencephalographic characteristics of status epilepticus after cardiac arrest. Clin Neurophys. 2017;128:681–8.

    Article  Google Scholar 

  6. Grossestreuer AV, Abella BS, Leary M, Perman SM, et al. Time to awakening and neurologic outcome in therapeutic hypothermia-treated cardiac arrest patients. Resuscitation. 2013;84:1741–6.

    Article  PubMed  Google Scholar 

Infectious References

  1. Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med. 2001;345:1727–33.

    Article  CAS  PubMed  Google Scholar 

  2. Trunkel SR, Hartman BJ, Kaplan SL, Kaufman BA, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267–84.

    Article  Google Scholar 

  3. Brouwer MC, McIntyre P, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015;(9):CD004405.

    Google Scholar 

  4. Gans d, van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002;347:1549–56.

    Article  PubMed  Google Scholar 

  5. Michael B, Menezes BF, Cunniffe J, Miller A, et al. Effect of delayed lumbar punctures on the diagnosis of acute bacterial meningitis in adults. Emerg Med J. 2010;27(6):433–8.

    Article  PubMed  Google Scholar 

  6. Brouwer MC, Thwaites GE, Tunkel AR, van de Beek D. Dilemmas in the diagnosis of acute community-acquired bacterial meningitis. Lancet. 2012;380(9854):1684–92.

    Article  PubMed  Google Scholar 

  7. Solomon T, Hart IJ, Beeching NJ. Viral encephalitis: a clinician’s guide. Pract Neurol. 2007;7(5):288–305.

    Article  PubMed  Google Scholar 

  8. Whitley RJ, Soong SJ, Linnerman C, et al. Herpes simplex encephalitis: clinical assessment. JAMA. 1982;247(3):317–20.

    Article  CAS  PubMed  Google Scholar 

  9. Raschilas F, Wolff M, Delatour F, Chaffaut C, et al. Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a multicenter study. Clin Infect Dis. 2002;35(3):254–60.

    Article  PubMed  Google Scholar 

  10. Day JN. Cryptococcal meningitis. Pract Neurol. 2004;4:274–85.

    Article  Google Scholar 

  11. Murthy JM, Sundaram C. Fungal infections of the central nervous system. Handb Clin Neurol. 2014;121:1383–401.

    Article  CAS  PubMed  Google Scholar 

Inflammatory References

  1. Dubey D, Pittock SJ, Kelly CR, McKeon A, et al. Autoimmune encephalitis: epidemiology and a comparison to infectious encephalitis. Ann Neurol. 2018;83:166–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Lancaster E. The diagnosis and treatment of autoimmune encephalitis. J Clin Neurol. 2016;12(1):1–13.

    Article  PubMed  Google Scholar 

  3. Dalmau J, Rosenfeld MR. Paraneoplastic and autoimmune encephalitis. In: Basow DS, editor. UpToDate. Waltham: UpToDate; 2012.

    Google Scholar 

  4. Rosenfeld M, Dalmau JO. Paraneoplastic disorders of the CNS and autoimmune synaptic encephalitis. Continuum (Minneap Minn). 2012;18:366–83.

    Google Scholar 

  5. Lawn ND, et al. Clinical, magnetic resonance imaging, and electroencephalographic findings in paraneoplastic limbic encephalitis. Mayo Clinic Proc. 2003;78:1363–8.

    Article  Google Scholar 

  6. Schiess N, Pardo CA. Hashimoto’s encephalopathy. Ann N Y Acad Sci. 2008;1142:254–65.

    Article  PubMed  Google Scholar 

Traumatic Brain Injury References

  1. Bullock MR, Chestnut R, Ghajar J, Gordon D, et al. Guidelines for the surgical management of traumatic brain injury author group. Neurosurgery. 2006;58(3):S2–1–S2–63.

    Article  Google Scholar 

  2. Izzy S, Mazwi NL, Martinez S, Spencer CA, et al. Revisiting grade 3 diffuse axonal injury: not all brainstem microbleeds are prognostically equal. Neurocrit Care. 2017;27(2):199–207.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Carney N, Totten AM, O’Reilly C, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2016;80(1):6–15.

    Article  Google Scholar 

Toxic Metabolic References

  1. Cryer PE. Hypoglycemia, functional brain failure, and brain death. J Clin Invest. 2007;117(4):868–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Fujioka M, Okuchi K, Hiramatsu KI, Sakaki T, et al. Specific changes in human brain after hypoglycemic injury. Stroke. 1997;28:584–7.

    Article  CAS  PubMed  Google Scholar 

  3. Kim JH, Koh SB. Extensive white matter injury in hypoglycemic coma. Neurology. 2007;68(13):1074.

    Article  PubMed  Google Scholar 

  4. Halawa I, Zelano J, Kumlien E. Hypoglycemia and risk of seizures: a retrospective cross-sectional study. Seizure. 2017;45:132.

    Article  PubMed  Google Scholar 

  5. Maccario M, Messis CP, Vastola EF. Focal seizures as a manifestation of hyperglycemia without ketoacidosis. Neurology. 1965;15(3):195.

    Article  CAS  PubMed  Google Scholar 

  6. Hennis A, Corbin D, Fraser H. Focal seizures and non ketotic hyperglycemia. J Neurol Neurosurg Psychiatry. 1992;55:195–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Stoner GD. Hyperosmolar hyperglycemic state. Am Fam Physician. 2005;71(9):1723–30.

    PubMed  Google Scholar 

  8. Brouns R, De Deyn PP. Neurological complications in renal failure: a review. Clin Neurol Neurosurg. 2004;107:1–16.

    Article  CAS  PubMed  Google Scholar 

  9. Seifter JL, Samuels MA. Uremic encephalopathy and other brain disorders associated with renal failure. Semin Neurol. 2011;31(2):139–43.

    Article  PubMed  Google Scholar 

  10. Wendon J, Lee W. Encephalopathy and cerebral edema in the setting of acute liver failure: pathogenesis and management. Neurocrit Care. 2008;9:97–102.

    Article  CAS  PubMed  Google Scholar 

  11. Tofteng F, Hauerberg J, Hansen BA, Pedersen CB, et al. Persistent arterial hyperammonemia increases the concentration of glutamine and alanine in the brain and correlates with intracranial pressure in patients with fulminant hepatic failure. J Cereb Blood Flow Metab. 2006;26(1):21–7.

    Article  CAS  PubMed  Google Scholar 

  12. Bjerring PN, Hauerberg J, Fredriksen HJ, Jorgensen L, et al. Cerebral glutamine concentration and lactate-pyruvate ratio in patients with acute liver failure. Neurocrit Care. 2008;9:3–7.

    Article  PubMed  Google Scholar 

  13. Raghavan M, Marik PE. Therapy of intracranial hypertension in patients with fulminant hepatic failure. Neurocrit Care. 2006;4:179–89.

    Article  CAS  PubMed  Google Scholar 

  14. Frontera JA, Kalb T. Neurological management of fulminant hepatic failure. Neurocrit Care. 2011;14:318–27.

    Article  PubMed  Google Scholar 

  15. Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med. 1998;339(22):1603–8.

    Article  CAS  PubMed  Google Scholar 

  16. Parker B. Emergency treatment of patients in coma due to drug intoxication; including treatment of carbon monoxide poisoning. Med Clin North Am. 1957;41(3):831–40.

    Article  CAS  PubMed  Google Scholar 

  17. Olson KR. Activated charcoal for acute poisoning: one toxicologist’s journey. J Med Toxicol. 2010;6:190–8.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Tintinalli JE, Stapczynski SO, Yealy DM, Meckler GD, et al. Tintinalli’s emergency medicine: a comprehensive study guide. 8th ed. New York: McGraw-Hill; 2016.

    Google Scholar 

  19. Kwaku MP, Burman KD. Myxedema coma. J Intensive Care Med. 2007;22:224–31.

    Article  PubMed  Google Scholar 

  20. Galvin R, Brathen G, Ivashynka A, Hillbom M, et al. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol. 2010;17:1408–18.

    Article  CAS  PubMed  Google Scholar 

  21. Sechi G, Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007;6(5):442–55.

    Article  CAS  PubMed  Google Scholar 

  22. Flynn A, Macaluso M, D’empaire I, Troutman MM. Wernicke’s encephalopathy: increasing clinician awareness of this serious, enigmatic, yet treatable disease. Prim Care Companion CNS Disord. 2015;17(3)

    Google Scholar 

Coma Exam References

  1. Teasdale G, Maas A, Lecky F, Manle G, et al. The Glasgow coma scale at 40 years: standing the test of time. Lancet Neurol. 2014;13:844–54.

    Article  PubMed  Google Scholar 

  2. Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, et al. Validation of a new coma scale: the FOUR score. Ann Neurol. 2005;58(4):585–93.

    Article  PubMed  Google Scholar 

  3. Gray AT, Krejci ST, Larson MD. Neuromuscular blocking drugs do not alter the pupillary light reflex of anesthetized humans. Arch Neurol. 1997;54(5):579–84.

    Article  CAS  PubMed  Google Scholar 

  4. Balofsky A, George J, Papadakos P. Neuropulmonology. Handb Clin Neurol. 2017;140:33–48.

    Article  CAS  PubMed  Google Scholar 

Study Indications References

  1. Oppenheim C, Stanescu R, Dormont D, et al. False-negative diffusion-weighted MR findings in acute ischemic stroke. Am J Neuroradiol. 2000;21:1434–40.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Herman ST, Abend NS, Bleck TP, Chapman KE, et al. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol. 2015;32(2):87–95.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Fortea JI, Banares R, Vaquero J. Intracranial pressure in acute liver failure: to bolt or not to bolt—that is the question. Crit Care Med. 2014;42(5):1304–5.

    Article  PubMed  Google Scholar 

  4. Karvellas CJ, Fix OK, Battenhouse H, Durkalski V, et al. Outcomes and complications of intracranial pressure monitoring in acute liver failure: a retrospective cohort study. Crit Care Med. 2014;42:1157–11673.

    Article  PubMed  PubMed Central  Google Scholar 

Brain Death References

  1. Löfstedt S, von Reis G. Intrakraniella lesioner med bilateralt upphävd kontrastpassage i a. carotis interna [intracranial lesions with abolished passage of x-ray contrast through the internal carotid arteries.]. Opusc Med. 1956;1:199–202.

    Google Scholar 

  2. Wertheimer P, Jouvet M, Descotes J. A propos du diagnostic de la mort du système nerveux dans les comas avec arrêt respiratoire traites par respiration artficielle. Presse Med. 1959;67:87–8.

    CAS  PubMed  Google Scholar 

  3. Mollaret P, Goulon M. Le coma dépassé (mémoire préliminaire). Rev Neurol. 1959;101:3–15.

    CAS  PubMed  Google Scholar 

  4. Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. A definition of irreversible coma: report of the ad hoc Committee of the Harvard Medical School to examine the definition of brain death. JAMA. 1968;205:337–40.

    Article  Google Scholar 

  5. Guidelines for the Determination of Death Report of the Medical Consultants on the Diagnosis of Death to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA 1981;246(19):2184–2186.

    Google Scholar 

  6. Wijdicks EFM. Determining brain death in adults. Neurology. 1995;45(5):1003–11.

    Article  CAS  PubMed  Google Scholar 

  7. Wijdicks EFM, Varelas PN, Gonseth GS, Greer DM. Evidence-based guideline update: determining brain death in adults: report of the quality standards sub-committee of the American Academy of Neurology. Neurology. 2010;74:1911–8.

    Article  PubMed  Google Scholar 

  8. American Academy of Pediatrics Task Force on Brain Death in Children. Guidelines for the determination of brain death in children. Pediatrics. 1987;80:298–300.

    Google Scholar 

  9. Nakagawa T, Ashwal S, Mathur M, Mysore M, Committee for Determination of Brain Death in Infants and Children. Guidelines for the determination of brain death in infants and children: an update of the 1987 Task Force Recommendations: executive summary. Ann Neurol. 2012;71:573–85.

    Article  PubMed  Google Scholar 

  10. Burkle CM, Schipper AM, Wijdicks EFM. Brain death and the courts. Neurology. 2011;76(9):837–41.

    Article  PubMed  Google Scholar 

  11. Wijdicks EFM. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology. 2002;58:20.

    Article  PubMed  Google Scholar 

  12. Wahlster S, Wijdicks EFM, Patel PV, Greer DM, Hemphill JC, Carone M, et al. Brain death declaration: practices and perceptions worldwide. Neurology. 2015;84(18):1870–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Citerio G, Crippa IA, Bronco A, Vargiolu A, Smith M. Variability in brain death determination in Europe: looking for a solution. Neurocrit Care. 2014;21(3):376–82.

    Article  PubMed  Google Scholar 

  14. Wang HH, Varelas PN, Henderson GV, Wijdicks EFM, Greer DM. Improving uniformity in brain death determination policies over time. Neurology. 2017;88(6):562–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Greer DM, Wang HH, Robinson JD, Varelas PN, Henderson GV, Wijdicks EFM. Variability of brain death policies in the United States. JAMA Neurol. 2016;73(2):213.

    Article  PubMed  Google Scholar 

  16. Lewis A, Bernat JL, Blosser S, Bonnie RJ, Epstein LG, Hutchins J, et al. An interdisciplinary response to contemporary concerns about brain death determination. Neurology. 2018;90(9):423–6.

    Article  PubMed  Google Scholar 

  17. Neurocritical Care Society. Brain death toolkit [Internet]. [cited 2018 Jun 18]. Available from: https://www.neurocriticalcare.org/education/digital-education/brain-death-toolkit

  18. Wijdicks E. Brain death guidelines explained. Semin Neurol. 2015;35(02):105–15.

    Article  PubMed  Google Scholar 

  19. Wijdicks EFM. The practice of emergency and critical care neurology. New York: Oxford University Press; 2010. p. 759–76.

    Book  Google Scholar 

  20. Šunjić KM, Webb AC, Šunjić I, Palà Creus M, Folse SL. Pharmacokinetic and other considerations for drug therapy during targeted temperature management. Crit Care Med. 2015;43(10):2228–38.

    Article  PubMed  CAS  Google Scholar 

  21. Saposnik G, Basile VS, Young GB. Movements in brain death: a systematic review. Can J Neurol Sci J Can Sci Neurol. 2009;36(02):154–60.

    Article  Google Scholar 

  22. Saposnik G, Bueri JA, Maurino J, Saizar R, Garretto NS. Spontaneous and reflex movements in brain death. Neurology. 2000;54(1):221.

    Article  CAS  PubMed  Google Scholar 

  23. Yee AH, Mandrekar J, Rabinstein AA, Wijdicks EF. Predictors of Apnea test failure during brain death determination. Neurocrit Care. 2010;12(3):352–5.

    Article  PubMed  Google Scholar 

  24. McGee WT, Mailloux P. Ventilator autocycling and delayed recognition of brain death. Neurocrit Care. 2011;14(2):267–71.

    Article  PubMed  Google Scholar 

  25. Eelco FM, Wijdicks MD, Edward M, Manno MD, Steven R, Holets RTT. Ventilator self-cycling may falsely suggest patient effort during brain death determination. Neurology. 2005;65(5):774.

    Google Scholar 

  26. Garrett MP, Williamson RW, Bohl MA, Bird CR, Theodore N. Computed tomography angiography as a confirmatory test for the diagnosis of brain death. J Neurosurg. 2018;128(2):639–44.

    Article  PubMed  Google Scholar 

  27. Kramer AH, Roberts DJ. Computed tomography angiography in the diagnosis of brain death: a systematic review and meta-analysis. Neurocrit Care. 2014;21:539.

    Article  PubMed  Google Scholar 

  28. Kramer A. Ancillary testing in brain death. Semin Neurol. 2015;35(02):125–38.

    Article  PubMed  Google Scholar 

  29. Kompanje E. Families and brain death. Semin Neurol. 2015;35(02):169–73.

    Article  PubMed  Google Scholar 

  30. Lewis A, Varelas PN, Greer DM. Prolonging support after brain death: when families ask for more. Neurocrit Care. 2016;24:481–7.

    Article  PubMed  Google Scholar 

  31. Burkle CM, Sharp RR, Wijdicks EF. Why brain death is considered death and why there should be no confusion. Neurology. 2014;83:1464–9.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Fugate J, Rabinstein A, Wijdicks EFM. Blood pressure patterns after brain death. Neurology. 2011;77:839.

    Google Scholar 

  33. Shewmon DA. Chronic “brain death”: meta-analysis and conceptual consequences. Neurology. 1998;51:1538–45.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Neurology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA

    Anna M. Cervantes-Arslanian & David M. Greer

  2. Departments of Neurosurgery, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA

    Anna M. Cervantes-Arslanian & David M. Greer

  3. Departments of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA

    Anna M. Cervantes-Arslanian

  4. Department of Neurology, Baystate Medical Center, Springfield, MA, USA

    Melissa Mercado

Authors
  1. Anna M. Cervantes-Arslanian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Melissa Mercado
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David M. Greer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anna M. Cervantes-Arslanian .

Editor information

Editors and Affiliations

  1. Johns Hopkins University, Baltimore, MD, USA

    Sarah E. Nelson

  2. Johns Hopkins University, Baltimore, MD, USA

    Paul A. Nyquist

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Cervantes-Arslanian, A.M., Mercado, M., Greer, D.M. (2020). Coma and Brain Death. In: Nelson, S., Nyquist, P. (eds) Neurointensive Care Unit. Current Clinical Neurology. Humana, Cham. https://doi.org/10.1007/978-3-030-36548-6_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-36548-6_7

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-36547-9

  • Online ISBN: 978-3-030-36548-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation