Eye-opening in brain death: A case report and review of the literature

• Published in: Clinical neurophysiology practice 2022-01, Vol.7, p.139-142
• Main Authors: Focardi, Martina, Gualco, Barbara, Scarpino, Maenia, Bonizzoli, Manuela, Defraia, Beatrice, Carrai, Riccardo, Lanzo, Giovanni, Raddi, Silvia, Bianchi, Ilenia, Grippo, Antonello
• Format: Article
• Language: English
• Subjects: Brain death; Case Report; Cerebral angiography; Eyelid elevation; Physical examination spinal reflexes
• ISSN: 2467-981X; 2467-981X
• DOI: 10.1016/j.cnp.2022.03.006

•Careful attention is needed at the time of clinical examination to rule out any cerebrally mediated function.•In some cases it may be difficult to distinguish spinally mediated responses from cerebrally mediated responses.•In these instances, ancillary testing may be required. According to Italian law, brain death is diagnosed when the patient is in a coma, showing the absence of respiratory drive under specific clinical conditions, and without any brain stem reflexes. On the other hand, presence of spinal reflexes, when correctly identified, does not hamper the diagnosis. We present a case of eyelid elevation two seconds after thoracic pain stimulation in a patient who otherwise fulfilled all clinical and instrumental brain-death criteria due to a residual preserved function of the superior cervical ganglion. Although the observed reflex is to be considered extracerebral, and therefore it should not hamper the diagnosis of BD, the authors propose implementing cerebral flow evaluation, considered “prudential”, as a preliminary assessment before determining BD.