Brain stem death (patient information)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Jinhui Wu, MD

Overview

Brain stem is the inner part of the brain that is connected to the spinal cord. It is responsible for regulating most of the automatic functions of the body that are essential for life, including breathing, heartbeat, blood pressure and swallowing. Further more, the brain stem plays a vital role in core functions such as consciousness, awareness and movement. Brain stem death means that the brain stem stops working, not sending messages to the body to control such core functions, at the same time, not receiving messages back from the body. Once brain stem occurs, there is no chance to recover.

What are symptoms of Brain stem death?

• No pupillary response to light
• No blanking on corneal touch
• No eye movement on caloric testing
• No grimacing on paiful stimuli
• No cough reflex or gag reflex
• No vestibulo-ocular reponse

What causes Brain stem death?

• Severe brain swelling after a serious fall or traffic accident or trauma
• Massive cerebral hemorrhage
• Severe or long time of anoxia

Diagnosis

A series of strict tests need to be carried out by two senior doctors who are not members of transplant team. The tests are done at the patient's bedside. These tests are frequently repeated to confirm that the patient's brain stem has stopped working. All the following criteria need to be met before brain stem death can be pronounced.

• Clinical tests for absent brain stem reflexes

• No pupillary response to light
• No blanking on corneal touch
• No eye movement on caloric testing
• No grimacing on paiful stimuli
• No cough reflex or gag reflex
• No vestibulo-ocular reponse

• Test for confirmation of persistent apnoea. The procedure is the following:

• Preoxygenation with 100% oxygen for 10 minutes
• Allow PaCO2 to rise above 5.0 kPa before test
• Disconnect from ventilator
• Maintain adequate oxygenation during test
• Allow PaCO2 to climb above 6.65 kPa
• Confirm no spontaneous respiration
• Reconnect ventilator

Diseases with similar symptoms

• Persistent vegetative state (PVS): Patients in a PVS has no feeling mental distress, or physical pain, or awareness of the surroundings. The difference between PVS and brain stem death is whether the core functions are affected. For patients with PVS, there is a slim chance to recover.But for the patients with brain stem death, there is no chance once their brain stem has died. All of the core functions of the body have stopped working and can never be restarted.

Where to find medical care for brain stem death?

Directions to Hospitals Treating brain stem death