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Brain death

Overview

Brain death is the permanent and irreversible cessation of arousal, wakefulness, accompanied by total and irreversible loss of brain stem reflexes, including breathing, coughing, eye movement, and swallowing.

  • Hypoxic brain damage
  • Trauma
  • Vascular- ischemic / haemorrhagic stroke
  • Fulminant systemic/ brain infections
  • Inflammatory conditions- vasculitis
  • Autoimmune conditions- neurosarcoidosis

  • Cardiopulmonary arrest
  • Traumatic brain injury
  • Subarachnoid haemorrhage
  • Intracerebral haemorrhage
  • Other causes of brain death include heart attack, stroke, blood clot, infections like encephalitis or meningitis, and brain tumour

  • Fixed pupils with no response to light
  • Absence of corneal or conjunctival reflex
  • No response on caloric testing
  • Absence of spontaneous breathing
  • Absence of gag reflex
  • No motor response to painful stimulus
  • No respiratory movements on disconnection from ventilator, even after increase in CO2 in blood

  • The aetiology for irreversible brain damage should be confirmed.
  • The causes of coma such as sedative medications, hypothermia, metabolic and endocrine causes should be excluded
  • The Patient should be hemodynamically stable on ventilator

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