The MRI of Jahi McMath and Its Implications for the Global Ischemic Penumbra Hypothesis
| Autor: | D. Alan Shewmon, Noriko Salamon |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Brain Death
medicine.medical_specialty Adolescent Thalamus White matter Internal medicine Basal ganglia medicine Humans medicine.diagnostic_test business.industry Penumbra Brain Apnea Magnetic resonance imaging Magnetic Resonance Imaging medicine.anatomical_structure Hypoxia-Ischemia Brain Pediatrics Perinatology and Child Health Cardiology Female Neurology (clinical) Brainstem medicine.symptom business Reticular activating system |
| Zdroj: | Journal of Child Neurology. 37:35-42 |
| ISSN: | 1708-8283 0883-0738 |
| DOI: | 10.1177/08830738211035871 |
| Popis: | Jahi McMath was diagnosed brain dead on 12/12/2013 in strict accordance with both the pediatric and adult Guidelines, reinforced by 4 isoelectric electroencephalograms and a radionuclide scan showing intracranial circulatory arrest. Her magnetic resonance imaging scan 9 1/2 months later surprisingly showed gross integrity of cortex, basal ganglia, thalamus, and upper brainstem. The greatest damage was in the white matter, which was extensively demyelinated and cystic, and in the lower brainstem, most likely from partial herniation that resolved. The apparent integrity of gray matter and the ascending reticular activating system may have provided a potential structural basis for the reemergence of some limited brain functions, while the white matter and lower brainstem lesions would have caused severe motor disability, brainstem areflexia and apnea. The findings indicate that there could never have been a period of sustained intracranial circulatory arrest. Rather, at the time of brain death diagnosis, low blood flow below the detection threshold of the radionuclide scan was sufficient to maintain widespread neuronal viability, though insufficient to support synaptic function. Her case represents the first indirect confirmation of the reality and clinical relevance of global ischemic penumbra, hypothesized in 1999 as a generally unacknowledged and possibly common brain death mimic. |
| Databáze: | OpenAIRE |
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