Cause of Death & Brain Autopsies-Bertetta

Question 1

What is shock?

Answer 1

• Acute circulatory failure
• Inadequate tissue perfusion
• End organ injury

Question 2

What is Extracorporeal Membrane Oxygenation (ECMO)?

Answer 2

Machine used to oxygenate, warm and filter blood

Question 3

What is required on a death certificate?

Answer 3

• CDC requires single immediate cause of death.

- Not: infirmity, senescence, failure to thrive

Question 4

How does the Uniform Determination of Death Act define death?

Answer 4

• Irreversible cessation of all functions of the entire brain including the brainstem
• Based on Harvard definition

Question 5

What is the Harvard definition of brain death?

Answer 5

• Unreceptive and unresponsive (ie painful stimuli)
• No movements or spontaneous breathing (turn off respirator)
• No reflexes (pupillary, muscular)
• Flat EEG

Question 6

What are the top 3 leading causes of death?

Answer 6

1. Heart disease
2. Cancer
3. Stroke

Question 7

What is DIC?

Answer 7

• Disseminated intravascular coagulopathy

- Not a cause of death according to the CDC

Question 8

What is clinical death?

Answer 8

Cessation of blood circulation and breathing but this can be reversed w/ CPR, heart-lung machine and/or defib

Question 9

What is the Glasgow Coma Scale used for?

Answer 9

Baseline level of consciousness assessment in acute medical and trauma cases (eye, verbal and motor)

Question 10

Describe cingulate, uncus and tonsilar cerebral herniations.

Answer 10

• Cingulate: brain is pushed underneath the falx cerebra
• Uncus: brain pushed under tentorium cerebella
• Tonsilar: tonsils of the cerebellum put pressure on the brainstem. (leads to stoppage of breathing)

Question 11

What is a minimally conscious state and how can you communicate w/pts in this state?

Answer 11

- Your brain is not functioning at this time (persistent coma)
• Usually resolves
- fMRI response to patient’s name
• “yes” and “no” imagination states
• Ask if they are in pain
• EEGs can also be used to ask questions

Question 12

What is a persistent vegetative state?

Answer 12

• Brainstem is functioning but the cerebral hemispheres are not (no EEG)
• Not recognized as death

Question 13

What are 2 types of occlusive strokes?

Answer 13

1. Embolic

2. tPA

Question 14

What are 3 types of hemorrhagic strokes?

Answer 14

1. Ruptured aneurysm
2. HTN parenchymal
3. Anticoagulant usage stroke

Question 15

What are some neurodegenerative diseases and what can they cause?

Answer 15

• Alzheimer’s, senile dementia, vascular (multi-infarct) dementia, frontotemporal lobe dementia, and MS.
• All of these cause dementia (except MS)

Question 16

What is cerebral atrophy and what can it lead to?

Answer 16

• Non-necrotic loss of neuronal tissues in cerebral hemispheres
• Can lead to ex-vacuo hydrocephalus (enlargement of ventricles w/o increase in ICP) (aka ventricular dilation)

Question 17

What are the most likely causes of spinal cord tumors and what can they lead to?

Answer 17

• Not likely to have been from the actual spinal cord but most likely a result of meningioma or schwannoma
• Leads to compression of medulla and thus respiratory failure