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Pitfalls in Diagnosing Brain Death in Infancy

Department of Neurology, Loyola University Medical Center, Chicago, IL

Lester L. Lansky, MD

Department of Neurology, University of Illinois Medical Center, Department of Pediatrics, University of Illinois Medical Center

John R. Hughes, MD, PhD

Department of Neurology, University of Illinois Medical Center

Michael J. Blend, DO, PhD

Department of Medicine, University of Illinois Medical Center

D.G. Pavel, MD

Department of Medicine, University of Illinois Medical Center

Susan A. Kecskes, MD

Department of Pediatrics, University of Illinois Medical Center

Romulo E. Ortega, MD

Department of Pediatrics, University of Illinois Medical Center

Walter S. Tan, MD

Department of Radiology, University of Illinois Medical Center, Chicago, IL

A 3-year-old child with phenotypic trisomy 18 syndrome survived 26 days after a cardiopulmonary arrest, secondary to an acute viral illness. The child was deeply comatose. No barbiturates, other sedatives, or aminoglycoside antibiotics had been recently administered. The child was normothermic with adequate cardiovascular function. Brain stem function was absent, as assessed by testing of brain stem reflexes. Serial cerebral radionuclide angiograms (CRAG) documented intact cerebral blood flow while electrocerebral silence (ECS) was present on two consecutive EEG recordings within 24 hours. Preservation of intracranial circulation was confirmed by rapid rotational computed tomographic (CT) scans. Cranial CT scans also revealed communicating hydrocephalus, and bilateral basal ganglia hemorrhages. This unusual case illustrates discordance between apparent irreversible loss of cortical function as indicated by electrocerebral silence with preserved cerebral blood flow. The implications of these apparent paradoxical events will be discussed in the context of defining brain death in children. ( J Child Neurol 1987;2:134-138).

Journal of Child Neurology, Vol. 2, No. 2, 134-138 (1987)
DOI: 10.1177/088307388700200209


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