Brain Death & ALS

Question 1

What are the signs of brain death?

Answer 1

• No spontaneous movement
• Absence of brain stem reflexes
  
  • Pupils fixed and dilated
  • No corneal reflexes
  • Absent doll’s eyes
  • Absent gag reflex
  • Absent vestibular response to caloric stimulation
• Absence breathing drive (apnea)

Question 2

When can you NOT declare a patient brain dead?

Answer 2

Cannot declare a patient brain dead in the following situations:

1. Hypothermic (<32C)
2. Drug intoxication or poisoning
3. Severe electrolyte, acid base or endocrine imbalance

Question 3

What tests are used to determine brain death?

Answer 3

• EEG
• Cerebral angiogram
• Transcranial doppler
• Cerebral blood flow study
• CT angiogram of brain

Question 4

What is ALS?

Answer 4

• Lou Gehrig’s disease
• It is a progressive neurodegenerative disease affecting nerve cells in the brain and spinal cord
• Symptoms present largely with weakness in upper and lower extremities

Question 5

What diagnostic tests are used to diagnose ALS?

Answer 5

• Serum CK- slight elevation
• EMG- denervation
• Muscle biopsy- small regions grouped with atrophic muscle fibers
• MRI- no abnormality that can explain Upper Motor Neuron alterations