Spontaniczna czynność ruchowa po rozpoznaniu śmierci pnia mózgu – opis przypadku

Waldemar Iwańczuk

Summary
Brain stem death has been defined as the irreversible loss of all functions of the brain and brainstem. Criteria for the diagnosis of brain death include total lack of responses, persistent apnea and the absence of brain stem reflexes. Spontaneous and reflex movements may occur, originating from the spinal cord neurons. They do not exclude brain death and are observed in approximately 13-87% of brain dead patients. Case report. A 44-year-old man was admitted to the hospital because of a subarachnoid hemorrhage from a ruptured aneurysm. The treatment was unsuccessful and the patient was declared brain dead 24 hours after admission. He was identified as a potential organ donor. Eight hours later, he twice raised his torso and crossed his arms in a prayer position. His movements were accompanied by a significant adrenergic response (tachycardia, dramatically increased blood pressure, hyperthermia and hypercapnia). Hyperventilation was started and after 30 minutes all signs resolved, the patient becoming bradycardic and subsequently asystolic. Discussion. The described situation was probably caused by severe adrenergic stimulation during herniation of brain stem structures, and may occur in brain stem dead patients. So-called Lazarus signs have been observed previously, including during organ collection. Lack of knowledge of this phenomenon may lead to misinterpretation, canceling of organ collection and legal consequences

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