Reader Response: Practice Current: When do you order ancillary tests to determine brain death?

We recently reported a case (case 3 in our article)1 contributing to the discussion of using ancillary tests in brain death.2 This case showed brain death clinical features leading to a death certification. We studied the case 9 months later.1 We found preservation of intracranial structures, with a huge lesion at the brainstem.1 Conceptually, brain death is characterized by absence of cerebral blood flow.3 Conservancy of brain structures rejects brain death diagnosis.1,3 EEG signal was found in this case. EEG signal may persist in posterior fossa catastrophes.2 Using heart rate variability (HRV) methodology, we found preservation of all HRV bands, contrary to reports in brain death.4 This case also showed autonomic reactivity to "mother talks" stimulation. This is a demonstration of autonomic CNS activity preservation.1 Our patient showed brain death clinical features, but the use of ancillary tests denied this diagnosis. We claimed that this is a new state, not previously classified, of a disorder of consciousness.1 Is there a diagnosis of any disease in which a confirmatory test (blood test, imaging) is not used, considering that pitfalls in clinical examination can occur? Brain death determination is the most challenging diagnosis for a physician. Why not use a confirmatory test?1,5

Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Machado, C., Estevez, M. Tags: The Nerve! Readers Speak Source Type: research