Difficulties in assessing brain death in a case of benzodiazepine poisoning with persistent cerebral blood flow

  title={Difficulties in assessing brain death in a case of benzodiazepine poisoning with persistent cerebral blood flow},
  author={Fr{\'e}d{\'e}ric Marrache and Bruno M{\'e}garbane and S Pirnay and Abdel Rhaoui and Marie Thuong},
  journal={Human and Experimental Toxicology},
  pages={503 - 505}
Assessing brain death may sometimes be difficult, with isoelectric EEG following psychotrope overdoses or normal cerebral blood flow (CBF) persisting despite brain death in the case of ventricular drainage or craniotomy. A 42-year-old man, resuscitated after cardiac arrest following a suicidal ingestion of ethanol, bromazepam and zopiclone, was admitted in deep coma. On day 4, his brainstem reflexes and EEG activity disappeared. On day 5, his serum bromazepam concentration was 817 ng/ml… 

Diagnosis of brain death

The methodology of diagnosing death, based on finding any of the signs of death, is reviewed, which shows that the irreversible loss of cardio-circulatory and respiratory functions can cause death only when ischemia and anoxia are prolonged enough to produce an irreversible destruction of the brain.

A Review of Ancillary Tests in Evaluating Brain Death

  • M. HeranN. HeranS. Shemie
  • Medicine
    Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques
  • 2008
The history of diagnosis ofbrain death, pathophysiologic issues in making this determination, and currently available CBF imaging techniques are reviewed, discussing each in turn with respect to their utility in the diagnosis of brain death.

Alprazolam and lorazepam overdose and the absence of brainstem reflexes

A 70-year-old unresponsive woman was hypothermic and had rapid shallow breathing, with pinpoint pupils and absent corneal, oculocephalic and oculovestibular reflexes, and the cause of her unconsciousness was uncovered when her husband found empty bags of alprazolam and lorazepam.

Transcranial Doppler ultrasonography to confirm brain death: a meta-analysis

CCA by TCD in the anterior and posterior circulation predicted fatal brain damage in all patients; therefore, TCD can be used to determine the appropriate moment for angiography.

Limitations of computed tomographic angiography in the diagnosis of brain death

In clinically BD patients with no electroencephalographic activity CT-a documents opacification of the intracerebral vessels in a significant percentage of the cases and cannot be recommended as a means of BD diagnosis.

Brain death diagnosis

Brain death (BD) diagnosis should be established based on the following set of principles, i.e. excluding major confusing factors, identifying the cause of coma, determining irreversibility, and

The evolution of brain death.

Pitfalls in the Diagnosis of Brain Death

Every step in the determination of brainDeath bears potential pitfalls which can lead to errors in the diagnosis of brain death, and possible solutions are identified.

Impact of Skull Defects on the Role of CTA for Brain Death Confirmation

CTA had a high diagnostic accuracy and reproducibility to confirm brain death in patients with an intact skull and the modified Frampas criteria increased the sensitivity of CTA, particularly in Patients with a skull defect.



Reliability in diagnosis of brain death

This study suggests that cerebral angiography and CBF studies are the most reliable investigations whereas the role of EEG and TCD remains to be determined because of the presence of false negatives and positives.

Intravenous angiography in brain death: report of 140 patients

In sedated patients in whom EEG and evoked brain-stem responses are non-diagnostic, or in order to shorten the observation time, transcranial Doppler should be performed to determine the appropriate moment for IV DSA, which is a reliable method of confirming brain death.

The role of transcranial Doppler in confirming brain death

With appropriate guidelines for performance and interpretation, TCD could be incorporated into institutional protocols as a rapid and convenient alternative to EEG for confirmation of brain death.

Brain death: MR and MR angiography.

Four patients in whom brain deaths was identified on the basis of neurologic and electroencephalographic findings were examined with MR imaging and MR angiography, showing diffuse swelling of the cerebral gyri and cerebellar cortex and loss of flow void in the intracranial portions of both internal carotid arteries.

Diffusion-Weighted Magnetic Resonance Imaging in Brain Death

Diffusion-weighted MRI showed diffuse hyperintensities involving both hemispheres as well as a severe drop in the apparent diffusion coefficient in both affected Hemispheres in a case of brain stem stroke.

Angiographic appearances in acute intracranial hypertension

Investigating cases of proved subarachnoid hemorrhage in which there was narrowing of the internal carotid artery in the neck and failure to demonstrate the intracranial vessels found a high percentage of cases of intraventricular hemorrhage, and this will be discussed later.

Clinical experience with the benzodiazepine antagonist flumazenil in suspected benzodiazepine or ethanol poisoning.

Flumazenil proved to be useful for diagnosing benzodiazepine or ethanol intoxication and in one patient with coma due to carbamazepine overdose, flumazanil was also found to be effective.

Specific Treatment of Benzodiazepine Overdose

The introduction of Ro 15-1788 is supported as a useful antidote in the diagnosis and the treatment of drug-induced coma and CNS depression improved in all the patients despite incomplete awakening.

European brain death codes: a comparison of national guidelines

The present study examined the similarities and differences in current concepts of brain death in the various European countries and their recommendations for the diagnosis ofbrain death.

The diagnosis of brain death.

  • E. Wijdicks
  • Medicine
    The New England journal of medicine
  • 2001
In the United States, the principle that death can be diagnosed by neurologic criteria (designated as brain death) is the basis of the Uniform Determination of Death Act, although the law does not define any of the specifics of the clinical diagnosis.