What Is Brain Death?

Brain Death

Brain death is a legal definition of death. It is the complete stopping of all brain functions and cannot be reversed. It means that, because of extreme and severe trauma or injury to the brain, the body’s blood supply to the brain is blocked, and the brain dies. Brain death is death. It is permanent. It differs from a persistent vegetative state, in which the person is alive, and some autonomic functions remain. It is also distinct from an ordinary coma, whether induced medically or caused by injury and illness, even if it is intense, as long as some brain and bodily activity and function remain. It is also not the same as the condition known as locked-in syndrome. Differential diagnosis can medically distinguish these differing conditions. 

Brain death is used as an indicator of legal death in many jurisdictions. Still, it is defined as inconsistently and often confused by the lay public. Various parts of the brain may keep functioning when others do not anymore, and the term “brain death” has been used to refer to multiple combinations.  

A brain-dead individual has no clinical evidence of brain function upon physical examination. This includes no response to pain and no cranial nerve reflexes. Reflexes include a pupillary response (fixed pupils), oculo-cephalic reflex, corneal reflex, no response to the caloric reflex test, and no spontaneous respirations. 

Brain death can sometimes be challenging to differentiate from other medical states such as barbiturate overdose, alcohol intoxication, sedative overdose, hypothermia, hypoglycemia, coma, and chronic vegetative states. Some comatose patients can recover to pre-coma or near the pre-coma level of functioning, and some patients with severe irreversible neurological dysfunction will nonetheless retain some lower brain functions, such as spontaneous respiration, despite the losses of both cortex and brain stem functionality.  

Brain death differs from other states of unconsciousness in important ways. For example, coma is similar to deep sleep, except that no amount of external stimuli can prompt the brain to become awake and alert. However, the person is alive and recovery is possible. Brain death is often confused with a persistent vegetative state, but these conditions are not the same either. A persistent vegetative state means the person has lost higher brain functions, but their undamaged brain stem still allows essential functions like heart rate and respiration to continue. 

Brain electrical activity can stop completely, or drop to such a low level as to be undetectable with most equipment. An EEG will, therefore, be flat, though this is sometimes also observed during deep anesthesia or cardiac arrest. Although in some countries, a flat EEG test is not required to certify death, it is considered to have confirmatory value.  

Because life support machines maintain the person’s breathing and heart rate, they are warm to the touch. This gives the illusion that the person is still alive. Family members may hold a false hope that the person is just comatose and could wake up with time or treatment. It is important for the medical staff members to fully explain that brain death is final, and that the person is dead and has no chance of ever regaining consciousness again. 

Our brain is the most important organ of our body, it controls everything about us. Do take special care of your brain.  

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Until next time,

Team Doctor ASKY!


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