False-Positive Diagnosis of Brain Death Following the Pediatric Guidelines: Case Report and Discussion
| Autor: | D. Alan Shewmon |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
Brain Death medicine.medical_specialty Time Factors Intracranial Pressure Scintigraphy Head trauma Cerebral edema 03 medical and health sciences 0302 clinical medicine medicine Humans False Positive Reactions 030212 general & internal medicine Organ donation Diagnostic Errors Cerebral perfusion pressure Radionuclide Imaging Intracranial pressure medicine.diagnostic_test business.industry Electroencephalography Pentetic Acid medicine.disease Surgery Cerebral blood flow Cerebrovascular Circulation Child Preschool Life support Pediatrics Perinatology and Child Health Neurology (clinical) Tomography X-Ray Computed business 030217 neurology & neurosurgery |
| Zdroj: | Journal of Child Neurology. 32:1104-1117 |
| ISSN: | 1708-8283 0883-0738 |
| DOI: | 10.1177/0883073817736961 |
| Popis: | A 2-year-old boy with severe head trauma was diagnosed brain dead according to the 2011 Pediatric Guidelines. Computed tomographic (CT) scan showed massive cerebral edema with herniation. Intracranial pressures were extremely high, with cerebral perfusion pressures around 0 for several hours. An apnea test was initially contraindicated; later, one had to be terminated due to oxygen desaturation when the Pco2 had risen to 57.9 mm Hg. An electroencephalogram (EEG) was probably isoelectric but formally interpreted as equivocal. Tc-99m diethylene-triamine-pentaacetate (DTPA) scintigraphy showed no intracranial blood flow, so brain death was declared. Parents declined organ donation. A few minutes after withdrawal of support, the boy began to breathe spontaneously, so the ventilator was immediately reconnected and the death declaration rescinded. Two hours later, life support was again removed, this time for prognostic reasons; he did not breathe, and death was declared on circulatory-respiratory grounds. Implications regarding the specificity of the guidelines are discussed. |
| Databáze: | OpenAIRE |
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