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Brain Death

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Clinical Electroencephalography

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Abstract

The term “brain death” (BD) is used to indicate a clinical situation characterized by the irreversible loss of all brain functions; the identification of this condition is closely linked to the development of intensive care medicine that, with mechanical ventilation, allows the maintenance of somatic functions even when cerebral functions are ceased.

BD diagnosis is essentially based on the presence of three cardinal clinic criteria: 1) coma or unresponsiveness, 2) absence of brainstem reflexes 3) absence of spontaneous breathing, evaluated with apnea test. For BD diagnosis the following prerequisites must be scrupolously considered: knowledge of the proximate cause of coma and confirmation of its irreversibility; exclusion of confounding clinical variables (severe electrolyte, acid-base, endocrine disturbances); hypothermia and/or hypotension; drug intoxication or poisoning. Ancillary tests used in BD confirmation are represented by neurophysiological methods to highlight the loss of bioelectrical brain activity (EEG, evoked potential (EP)) and methods for demonstration of cerebral circulatory arrest (TransCranial Doppler (TCD); Single Photon Emission Computed Tomography ( SPECT); conventional Digital Subtraction Angiography (DSA); CT angiography; MRI angiography). There is insufficient evidence to determine whether ancillary tests are able to confirm the complete cessation of all brain functions and then, in adults, ancillary tests are not needed for the clinical diagnosis of brain death and they should never replace the clinical neurological examination.

However, even though ancillary tests are not mandatory but only optional in many countries, they continue to be used, especially when there are factors that may interfere with the complete clinical assessment or when apnea test cannot be performed. Although BD is a relatively simple clinical diagnosis, there are substantial differences in perceptions and practices regarding its declaration among countries, states and even between hospitals worldwide. There are also cultural and religious obstacles—especially in lower-income countries—to the determination of death with neurologic criteria, which lead to the suspension of mechanical ventilation. Therefore, health organizations should implement educational campaigns to improve knowledge and awareness of current criteria among the population, and national and international scientific societies should also make every efforts to validate and standardize clinical and laboratory criteria. Finally, it should reminded and underlined that the ultimate purpose of brain death determination should be to increase the number of organs donated, to improve the quality of life of organ recipients.

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Acknowledgments

We are very grateful to Dr. Patrizia Pulitano for her help in selecting and editing the EEG figures.

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Authors and Affiliations

  1. Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy

    Oriano Mecarelli

  2. Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy

    Edoardo Vicenzini

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  1. Oriano Mecarelli
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  2. Edoardo Vicenzini
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Correspondence to Oriano Mecarelli .

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  1. Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy

    Oriano Mecarelli

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Mecarelli, O., Vicenzini, E. (2019). Brain Death. In: Mecarelli, O. (eds) Clinical Electroencephalography. Springer, Cham. https://doi.org/10.1007/978-3-030-04573-9_47

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  • DOI: https://doi.org/10.1007/978-3-030-04573-9_47

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