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Movements in Brain Death: A Systematic Review

Published online by Cambridge University Press:  02 December 2014

Gustavo Saposnik ,
Vincenzo S. Basile  and
G. Bryan Young
Gustavo Saposnik*
Affiliation:
Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto Department of Health Policy, Management and Evaluation, University of Toronto, Toronto
Vincenzo S. Basile
Affiliation:
Department of Medicine, Division of Neurology, University of Toronto, Toronto Neurogenetics Section, Centre for Addiction and Mental Health, University of Toronto, Toronto
G. Bryan Young
Affiliation:
Department of Clinical Neurological Sciences and Critical Care Medicine, University of Western Ontario, London, Ontario, Canada
*
Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, 55 Queen St East, Toronto, Ontario, M5C 1R6, Canada
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Abstract

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Brain death is the irreversible lost of function of the brain including the brainstem. The presence of spontaneous or reflex movements constitutes a challenge for the neurological determination of death. We reviewed historical aspects and practical implications of the presence of spontaneous or reflex movements in individuals with brain death and postulated pathophysiological mechanisms. We identified and reviewed 131 articles on movements in individuals with confirmed diagnosis of brain death using Medline from January 1960 until December 2007, using ‘brain death’ or ‘cerebral death’ and ‘movements’ or ‘spinal reflex’ as search terms. There was no previous systematic review of the literature on this topic. Plantar withdrawal responses, muscle stretch reflexes, abdominal contractions, Lazarus's sign, respiratory-like movements, among others were described. For the most part, these movements have been considered to be spinal reflexes. These movements are present in as many as 40-50% of heart-beating cadavers. Although limited information is available on the determinants and pathophysiological mechanisms of spinal reflexes, clinicians and health care providers should be aware of them and that they do not preclude the diagnosis of brain death or organ transplantation.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 2 , March 2009 , pp. 154 - 160
Copyright
Copyright © The Canadian Journal of Neurological 2009

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