History and mechanism of brain death

Question 1

When was the concept of brain death first introduced?

Answer 1

1959

Question 2

What does pronouncing neurological death require?

Answer 2

Irreversible loss of consciousness

Irreversible loss of brainstem activity

Question 3

Is a vegetative state brain death and why?

Answer 3

No

Brainstem activity remains intact

Question 4

What kind of necrosis does the brain undergo in brain death?

Answer 4

Aseptic necrosis

Question 5

How can doctors prevent brain death due to injury?

Answer 5

Relieve presssure
- with Burr hole
- decompressive craniectomy
Guide medical therapy
- intracranial pressure monitor
- intracranial oxygenation monitor

Question 6

What is the Cushing reflex and what is it caused by?

Answer 6

High ICP -> brain + brainstem herniation
Decreased HR
Irregular breathing
Increased BP (body’s final attempt to maintain brain perfusion)

Question 7

What is the process of the brain herniating downwards called?

Answer 7

Coning

Question 8

What happens to the blood pressure after the brainstem herniates?

Answer 8

Falls rapidly

Drive to maintain perfusion is lost

Question 9

What is the time required to diagnose a ‘persistent’ vegetative state?

Answer 9

3 months

Question 10

What is the mechanism of a vegetative state?

Answer 10

High ICP -> cortices damaged

Brainstem preserved

Question 11

Patients in vegetative state have/do not have a preserved sleep wake cycle

Answer 11

Have a preserved sleep-wake cycle

Question 12

What is locked in syndrome

Answer 12

Part of brainstem damaged -> loss of motor and sensory ability below that level
Cerebral cortex is intact therefore patient is conscious

Question 13

What is the name of the first heart transplant donor?

Answer 13

Denise Darvall

Question 14

What is the name of the first heart transplant recipient?

Answer 14

Louis Washkansky