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Acta Medica Medianae Correspondence to: Calixto Machado Institute of Neurology and Neurosurgery 29 y D, Vedado La Habana 10400, Cuba E-mail: braind@infomed.sld.cu
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Review
article BRAIN DEATH DIAGNOSIS
Calixto Machado
Institute of Neurology and Neurosurgery, Department of Clinical Neurophysiology, Havana, Cuba
Brain death (BD) diagnosis should be established based on the following set of principles, i.e. excluding major confusing factors, identifying the cause of coma, determining irreversibility, and precisely testing brainstem reflexes at all levels of the brainstem. Nonetheless, most criteria for BD diagnosis do not mention that this is not the only way of diagnosing death. The Cuban Commission for the Determination of Death has emphasized the aforesaid three possible situations for diagnosing death: a) outside intensive care environment (without life support) physicians apply the cardio-circulatory and respiratory criteria; b) in forensic medicine circumstances, physicians utilize cadaveric signs (they do not even need a stethoscope); c) in the intensive care environment (with life support) when cardiorespiratory arrest occurs physicians utilize the cardio-circulatory and respiratory criteria. This methodology of diagnosing death, based on finding any of the death signs, is not related to the concept that there are different types of death. The irreversible loss of cardio-circulatory and respiratory functions can only cause death when ischemia and anoxia are prolonged enough to produce an irreversible destruction of the brain. The sign of irreversible loss of brain functions, that is to say BD diagnosis, is fully reviewed. Acta Medica Medianae 2009;48(3): 25-30. Key words: brain death, signs of death, brain death criteria, transcranial Doppler, multimodality- evoked potentials |