Skip to main content

Advertisement

SpringerLink
Log in

Spinal man after brain death

The unilateral extension-pronation reflex of the upper limb as an indication of brain death

  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

Sixty-three patients who fulfilled neurological, electroencephalographic and angiographic criteria of brain death were investigated longitudinally.

Spinal man during the first 200 hours after brain death is described. Most patients had bilateral mydriasis but unilateral mydriasis or bilateral non mydriatic pupils were also encountered. Poikilothermia was found in all patients later than 24 hours after brain death. Half the patients had diabetes insipidus.

Fifty patients retained or regained spinal reflex activity after brain death. Any of the ordinary deep and superficial reflexes except the plantar reflex could be present; however, if spinal reflexes were present, the flexion-withdrawal reflex was invariably there. The skin area from which the flexion reflex was elicited was congruent to the 3rd and 4th lumbar sensory dermatomes. Moreover, unilateral extension-pronation movements of the upper limb elicited from distinct skin fields congruent to the 8th cervical and all the thoracic sensory dermatomes emerged later than 6 hours after brain death. This reflex is a simple indicator of brain death of any aetiology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. J. Amer. Med. Ass.205 (1968), 337–340.

    Google Scholar 

  2. Arfel, G., Problèmes électroencéphalographiques de la mort. Paris: Masson. 1970.

    Google Scholar 

  3. Becker, D. P., C. M. Robert, J. R. Nelson, and W. E. Stern, An evaluation of the definition of cerebral death. Neurology20 (1970), 459–462.

    PubMed  Google Scholar 

  4. Chusid, J. G., and J. J. McDonald, Correlative neuroanatomy and functional neurology. Los Altos: Lange. 1967.

    Google Scholar 

  5. Feldman, M. H., and S. Sahrmann, The decerebrate state in the primate. Arch. Neurol.25 (1971), 517–525.

    PubMed  Google Scholar 

  6. Foerster, O., The dermatomes in man. Brain56 (1933), 1–39.

    Google Scholar 

  7. Fulton, J. F., and G. P. McCouch, The relation of the motor area of primates to the hyporeflexia (“spinal shock”) of spinal transection. J. Nerv. Ment. Dis.86 (1937), 125–146.

    Google Scholar 

  8. Hagbarth, K.-E., Excitatory and inhibitory skin areas for flexor and extensor motoneurones. Acta Physiol. Scand.26 (1952), suppl. 94.

    Google Scholar 

  9. Jørgensen, E. O., and P. Brodersen, Criteria of death. Nord. Med.86 (1971), 1549–1560.

    PubMed  Google Scholar 

  10. - Hemodynamic changes following aortocervical, internal carotid and vertebral angiography in suspected brain death. Acta Radiol. (Stockh.), in press.

  11. - EEG without detectable cortical activity and cranial nerve areflexia as parameters of brain death. Electroencephaloclin. Neurophysiol., in press.

  12. Kuhn, R. A., and M. B. Macht, Some manifestations of reflex activity in spinal man with particular reference to the occurrence of extensor spasms. Bull. Johns Hopkins Hosp.84 (1949), 43–75.

    Google Scholar 

  13. Langworthy, O. R., The mechanism of the abdominal and cremasteric reflexes. Arch. Neurol. Psychiat.24 (1930), 1023–1033.

    Google Scholar 

  14. Lindgren, P., and G. Törnell, Blood pressure and heart rate responses in carotid angiography with sodium acetrizoate (triurol). Acta Radiol. (Stockh.)50 (1958), 160–174.

    Google Scholar 

  15. Lønnum, A., The abdominal skin reflexes in man: An analysis of the reflex findings in early infancy and in patients with cerebral disease. Acta Psychiat. Neurol. Scand. (1957), suppl. 108.

  16. Mollaret, P., and M. Goulon, Le coma depassé. Rev. Neurol.101 (1959), 3–15.

    PubMed  Google Scholar 

  17. Monrad-Krohn, G. H., Reflexes of different order elicitable from the abdominal region. Arch. Neurol. Psychiat.66 (1950), 338–345.

    Google Scholar 

  18. Penin, H., and C. H. Käufer (eds.), Der Hirntod. Stuttgart: Thieme. 1969.

    Google Scholar 

  19. Schneider, H., W. Masshoff, and G. A. Neuhaus, Klinische und morphologische Aspekte des Hirntodes. Klin. Wschr.16 (1969), 844–859.

    Google Scholar 

  20. Schwartz, B. A., and E. Vendrely, Un des problèmes posés par le diagnostic du coma depassé: EEG nul et diametre pupillaire. Rev. Neurol.121 (1969), 319–323.

    PubMed  Google Scholar 

  21. Sherrington, G. S., Experiments in the examination of the peripheral distribution of the fibres of the posterior roots of some spinal nerves. Philos. Tr. Roy. Soc.190 (1898), 45–186.

    Google Scholar 

  22. —, Flexion reflex of the limb, crossed extensor reflex and reflex stepping and standing. J. Physiol.40 (1910), 28–121.

    Google Scholar 

  23. Silver, J. R., Vascular reflexes in spinal shock. Paraplegia8 (1970), 231–242.

    Google Scholar 

  24. Tönnis, W., and R. A. Frowein, Wie lange ist Wiederbelebung bei schweren Hirnverletzungen möglich? Mschr. Unfallheilk.66 (1963), 169–190.

    PubMed  Google Scholar 

Download references

Author information

Author notes

  1. E. O. Jørgensen

    Present address: Medical Department B and Neurosurgical Department of Rigshospitalet, Denmark

Authors and Affiliations

  1. Neurosurgical Department, Denmark

    E. O. Jørgensen

  2. Anesthesiological Department, Denmark

    E. O. Jørgensen

  3. The Poison Center of Bispebjerg Hospital, Copenhagen, Denmark

    E. O. Jørgensen

Authors
  1. E. O. Jørgensen
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported by the P. Carl Petersen Foundation and the Danish Heart Foundation.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jørgensen, E.O. Spinal man after brain death. Acta neurochir 28, 259–273 (1973). https://doi.org/10.1007/BF01405645

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01405645

Keywords

Search

Navigation