Hostname: page-component-745bb68f8f-l4dxg Total loading time: 0 Render date: 2025-02-03T00:21:34.189Z Has data issue: false hasContentIssue false
  • English
  • Français

Movements in Brain Death: A Systematic Review

Published online by Cambridge University Press:  02 December 2014

Gustavo Saposnik ,
Vincenzo S. Basile  and
G. Bryan Young
Gustavo Saposnik*
Affiliation:
Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto Department of Health Policy, Management and Evaluation, University of Toronto, Toronto
Vincenzo S. Basile
Affiliation:
Department of Medicine, Division of Neurology, University of Toronto, Toronto Neurogenetics Section, Centre for Addiction and Mental Health, University of Toronto, Toronto
G. Bryan Young
Affiliation:
Department of Clinical Neurological Sciences and Critical Care Medicine, University of Western Ontario, London, Ontario, Canada
*
Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, 55 Queen St East, Toronto, Ontario, M5C 1R6, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Brain death is the irreversible lost of function of the brain including the brainstem. The presence of spontaneous or reflex movements constitutes a challenge for the neurological determination of death. We reviewed historical aspects and practical implications of the presence of spontaneous or reflex movements in individuals with brain death and postulated pathophysiological mechanisms. We identified and reviewed 131 articles on movements in individuals with confirmed diagnosis of brain death using Medline from January 1960 until December 2007, using ‘brain death’ or ‘cerebral death’ and ‘movements’ or ‘spinal reflex’ as search terms. There was no previous systematic review of the literature on this topic. Plantar withdrawal responses, muscle stretch reflexes, abdominal contractions, Lazarus's sign, respiratory-like movements, among others were described. For the most part, these movements have been considered to be spinal reflexes. These movements are present in as many as 40-50% of heart-beating cadavers. Although limited information is available on the determinants and pathophysiological mechanisms of spinal reflexes, clinicians and health care providers should be aware of them and that they do not preclude the diagnosis of brain death or organ transplantation.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 2 , March 2009 , pp. 154 - 160
Copyright
Copyright © The Canadian Journal of Neurological 2009

References

1.Regnard, P, Loye, P.Death by decapitation. BMJ. 1887;ii:195.Google Scholar
2.Cabanis, PJG.Note sur le supplice de la guillotine (A note on execution by the guillotine). Magasin encyclopédique, Editions À L’ Orient. Paris: 1803. p. 163–83.Google Scholar
3.Practice parameters for determining brain death in adults. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1995; 45:1012–4.Google Scholar
4.Ad Hoc Committee of the Harvard Medical School to examine the definition of Brain Death. A definition of irreversible coma. JAMA. 1968; 205:337–40.CrossRefGoogle Scholar
5.Anonymous. Criteria for the determination of death. Law Reform Commission of Canada, Ottawa; 1981.Google Scholar
6.Guidelines for the determination of death. President′s Commission for the study of Ethical problems in Medicine and Biomedical and Behavioral research, Washington DC. JAMA. 1981;246: 2184–6.CrossRefGoogle Scholar
7.Diagnosis of Brain Death. Statement issued by the honorary secretary of the Conference of the Royal Colleges and Faculties of the United Kingdom. BMJ. 1976; 2:1187–8.Google Scholar
8.Jenkins, D, Reilly, P, Schwab, C.Improving the approach to organ donation: a review. World J Surg. 1999;23:644–9.CrossRefGoogle ScholarPubMed
9.Youngner, S, Landefeld, C, Coulton, C, Juknialis, B, Leary, M.Brain death and organ retrieval. A cross-sectional survey of knowledge and concepts among health professionals. JAMA. 1989;261:2205–10.CrossRefGoogle ScholarPubMed
10.Jain, S, DeGeorgia, S.Brain death-associated reflexes and automatisms. Neurocrit Care. 2005;3:122–6.CrossRefGoogle ScholarPubMed
11.Kandel, ER, Swartz, JH, Jessel, TM.Principles of Neural Sciences. 4th ed. New York: McGraw-Hill; 2000. p. 653–71.Google Scholar
12.Brown, TG.The intrinsic factors in the act of progression in the mammal. Proc Roy Soc London. 1911;84:308–19.Google Scholar
13.Tresch, MC, Saltiel, P, d′Avella, A, Bizzi, E.Coordination and localization in spinal motor systems. Brain Res Review. 2002;40:69–79.CrossRefGoogle ScholarPubMed
14.Ivan, LP.Spinal reflexes in cerebral death. Neurology. 1973;23: 650–2.CrossRefGoogle ScholarPubMed
15.Jorgensen, EO.Spinal man after brain death. The unilateral extension-pronation reflex of the upper limb as an indication of brain death. Acta Neurochir (Wien). 1973;28(4):259–73.Google ScholarPubMed
16.Conci, F, Porpaccio, F, Arosio, M, Bosselli, L.Viscero-somatic and viscero-visceral reflexes in brain death. J Neurol Neurosurg Psychiatry. 1986;49(6):695–8.CrossRefGoogle ScholarPubMed
17.Saposnik, G, Bueri, JA, Mauriño, J, Saizar, R, Garretto, N.Spontaneous and reflex movements in brain death. Neurology. 2000;54:221–3.CrossRefGoogle ScholarPubMed
18.Saposnik, G, Maurino, J, Saizar, R, Bueri, JA.Spontaneous and reflex movements in 107 patients with brain death. Am J Med. 2005 Mar;118(3):311–4.CrossRefGoogle ScholarPubMed
19.Han, SG, Kim, GM, Lee, KH, Chung, CS, Jung, KY.Reflex movements in patients with brain death: a prospective study in a tertiary medical center. J Korean Med Sci. 2006 Jun;21(3): 588–90.CrossRefGoogle ScholarPubMed
20.Döşemeci, L, Cengiz, M, Yilmaz, M, Ramazanoglu, A.Frequency of spinal reflex movements in brain-dead patients. Transplant Proc. 2004 Jan-Feb;36(1):17–9.CrossRefGoogle ScholarPubMed
21.Mandel, S, Arenas, A, Scasta, D.Spinal automatism in cerebral death. N Engl J Med. 1982;307:501.Letter.Google ScholarPubMed
22.Ropper, A.Unusual spontaneous movements in brain death patients. Neurology. 1984;34:1089–92.CrossRefGoogle Scholar
23.Urasaki, E, Fukumura, A, Itho, Y.Lazarus’ sign and respiratory-like movement in a patient with brain death. No To Shinkei. 1988;40:1111–6.Google Scholar
24.Turmel, A, Roux, A, Bojanowski, MW.Spinal man after declaration of brain death. Neurosurgery. 1991;28:298–301.CrossRefGoogle ScholarPubMed
25.Urasaki, E, Tokimura, T, Kumai, JI, Wada, SI, Yokota, A.Preserved spinal dorsal horn potentials in a brain-dead patient with Lazarus’ sign. J Neurosurg. 1992;76:710–3.CrossRefGoogle Scholar
26.Awada, A.Automatismes réflexes inhabituels après mort cérébrale. Rev Neurol (Paris). 1995;151:586–8.Google Scholar
27.Nokura, K, Yamamoto, H, Uchida, M, Hashizume, Y, Inagaki, T.Automatic movements of extremities induced in primary massive brain lesion with apneic coma. Rinsho Shinkeigaku. 1997;37:198–207.Google ScholarPubMed
28.Dequin, PF, Hazouard, E, Huguet, M, Delplace, C, Tayoro, J, Giniès, G.Signe de Lazare après mort encéphalique. Presse Med. 1998;27:1102.Google Scholar
29.Urasaki, E, Fukumura, A, Itho, Y, Itoyama, Y, Yamada, M, Ushio, Y, et al.Lazarus’ sign and respiratory-like movement in a patient with brain death. No To Shinkei. 1988;40:1111–6.Google Scholar
30.Bueri, JA, Saposnik, G, Mauriño, J, Saizar, R, Garretto, N.Lazarus′sign in brain death. Mov Disord. 2000;15:583–6.3.0.CO;2-Y>CrossRefGoogle ScholarPubMed
31.Heytens, L, Verlooy, J, Gheuens, J, Bossaert, L.Lazarus sign and extensor posturing in a brain-dead patient. J Neurosurg. 1989;71:449–51.CrossRefGoogle Scholar
32.Jordan, JE, Dyess, E, Cliett, J.Unusual spontaneous movements in brain-dead patients. Neurology. 1985;35:1082. Letter.CrossRefGoogle ScholarPubMed
33.McNair, NL, Meador, KJ.The undulating toe flexion sign in Brain Death. Mov Disord. 1992;7:345–7.CrossRefGoogle ScholarPubMed
34.Santamaria, J, Orteu, N, Iranzo, A, Tolosa, E.Eye opening in brain death. J Neurol. 1999;246:720–2.CrossRefGoogle ScholarPubMed
35.Turnbull, J, Rutledge, F.Spontaneous respiratory movements with clinical brain death. Neurology. 1985;35:1260.CrossRefGoogle ScholarPubMed
36.Christie, JM, O’Lenic, TD, Cane, RD.Head turning in brain death. J Clin Anesth. 1996; 8:141–3.CrossRefGoogle ScholarPubMed
37.Jokelainen, M, Mattila, R.Cephalic responses in brain death. BMJ. 1977;2:828.CrossRefGoogle ScholarPubMed
38.Marti-Fabregas, J, Lopez-Navidad, A, Caballero, F, Otermin, P.Decerebrate-like posturing with mechanical ventilation in brain death. Neurology. 2000;54 224–7.CrossRefGoogle ScholarPubMed
39.Saposnik, G, Maurino, J, Saizar, R.Facial Myokymia in brain death. Eur J Neurol. 2001;8:227–30.CrossRefGoogle ScholarPubMed
40.Mehta, AJSeshia, SS.Orbicular oculi reflex in brain death. J Neurol Neurosurg Psychiatry. 1976;39:784–7.CrossRefGoogle Scholar
41.Haupt, WF.Cranial muscle activity in dissociated brain death. Nervenartz. 1986;57:145–8.Google ScholarPubMed
42.Fujimoto, K, Yamauchi, Y, Yoshida, M.Spinal myoclonus in association with brain death. Rinsho Shinkeigaku. 1989;29:1417–9.Google ScholarPubMed
43.de Freitas, GR, Lima, MA, André, C.Complex spinal reflexes during transcranial Doppler ultrasound examination for the confirmation of brain death. Acta Neurol Scand. 2003 Sep;108 (3):170–3.CrossRefGoogle ScholarPubMed
44.Bohatyrewicz, R, Walecka, A, Bohatyrewicz, A, Zukowski, M, Kepiński, S, Marzec-Lewenstein, E, et al.Unusual movements, “spontaneous” breathing, and unclear cerebral vessels sonography in a brain-dead patient: a case report. Transplant Proc. 2007 Nov;39(9):2707–8.CrossRefGoogle Scholar
45.Dietz, V.Human neuronal control of automatic functional movements: interaction between central programs and afferent input. Physiol Rev. 1992;72:33–69.CrossRefGoogle ScholarPubMed
46.Benarroch, EE, Westmoreland, BF, Daube, JR, Reagan, TJ, Sandok, BA.The spinal level. In: Winters, R, editor. Medical neuroscience: an approach to anatomy, pathology and physiology by systems and levels. 4th ed. Rochester: Lippincott Williams & Wilkins; 1999. p. 425–64.Google Scholar
47.Jennett, B, Gleave, J, Wilson, P.Brain death in three neurosurgical units. BMJ. 1981;282:533–9.CrossRefGoogle ScholarPubMed