This case report illustrates the approach to the diagnosis of brain death, one of the most consequential decisions a neurologist is likely to face. The determination of brain death is made on clinical grounds and requires the documentation of absence of brain functions through a series of standardized tests, with assessment of consciousness, pupillary reflex, corneal reflex, oculocephalic reflex, oculovestibular reflex, cough reflex, gag reflex, and motor response. An apnea test then determines the absence of spontaneous respiratory activity. The brain death diagnosis also requires the exclusion of a number of confounding conditions. Ancillary tests are typically conducted only if the full examination is not otherwise possible. The process needs to be conducted in the context of thoughtful and compassionate interaction with the patient’s family.
This case report offers a good practical reminder and exercise for the diagnosis of brain death.