Implications of ischemic penumbra for the diagnosis of brain death

Implications of ischemic penumbra for the diagnosis of brain death

Autor Coimbra, Cicero Galli Autor UNIFESP Google Scholar
Instituição Universidade Federal de São Paulo (UNIFESP)
Resumo The data reviewed here suggest the possibility that a global reduction of blood supply to the whole brain or solely to the infratentorial structures down to the range of ischemic penumbra for several hours or a few days may lead to misdiagnosis of irreversible brain or brain stem damage in a subset of deeply comatose patients with cephalic areflexia. The following proposals are advanced: 1) the lack of any set of clinically detectable brain functions does not provide a safe diagnosis of brain or brain stem death; 2) apnea testing may induce irreversible brain damage and should be abandoned; 3) moderate hypothermia, antipyresis, prevention of arterial hypotension, and occasionally intra-arterial thrombolysis may contribute to good recovery of a possibly large subset of cases of brain injury currently regarded as irreversible; 4) confirmatory tests for brain death should not replace or delay the administration of potentially effective therapeutic measures; 5) in order to validate confirmatory tests, further research is needed to relate their results to specific levels of blood supply to the brain. The current criteria for the diagnosis of brain death should be revised.
Palavra-chave ischemic penumbra
cerebral ischemia
intracranial pressure
traumatic brain injury
brain death
hypothermia
thrombolysis
apnea test
Idioma Inglês
Data de publicação 1999-12-01
Publicado em Brazilian Journal of Medical and Biological Research. Associação Brasileira de Divulgação Científica, v. 32, n. 12, p. 1479-1487, 1999.
ISSN 0100-879X (Sherpa/Romeo, fator de impacto)
Publicador Associação Brasileira de Divulgação Científica
Extensão 1479-1487
Fonte http://dx.doi.org/10.1590/S0100-879X1999001200005
Direito de acesso Acesso aberto Open Access
Tipo Artigo
Web of Science WOS:000084453600004
SciELO S0100-879X1999001200005 (estatísticas na SciELO)
Endereço permanente http://repositorio.unifesp.br/handle/11600/858

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