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

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 inges...

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Bibliographic Details
Published in:Human & experimental toxicology 2004-10, Vol.23 (10), p.503-505
Main Authors: Marrache, Frédéric, Megarbane, Bruno, Pirnay, Stéphane, Rhaoui, Abdel, Thuong, Marie
Format: Article
Language:English
Subjects:
Adult
Anti-Anxiety Agents - blood
Anti-Anxiety Agents - poisoning
Biological and medical sciences
Brain Death - classification
Brain Death - diagnosis
Brain Death - physiopathology
Bromazepam - blood
Bromazepam - poisoning
Cardiology and cardiovascular system
Cerebral Angiography
Cerebrovascular Circulation
Drug intoxications. Doping
Drug Therapy, Combination
Electroencephalography
Emerging diseases
Fatal Outcome
Gas Chromatography-Mass Spectrometry
Human health and pathology
Humans
Infectious diseases
Life Sciences
Male
Medical sciences
Pharmacology. Drug treatments
Poisoning - pathology
Poisoning - physiopathology
Pulmonology and respiratory tract
Toxicology
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Summary: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 (therapeutic: 80-150). The patient was unresponsive to 1 mg of flumazenil. MRI showed diffuse cerebral swelling. CBF assessed by angiography and Doppler remained normal and EEG isoelectric until he died on day 8 with multiorgan failure. There was a discrepancy between the clinically and EEG-assessed brain death, and CBF persistence. We hypothesized that brain death, resulting from diffuse anoxic injury, may lead, in the absence of major intracranial hypertension, to angiographic misdiagnoses. Therefore, EEG remains useful to assess diagnosis in such unusual cases.
ISSN:0960-3271
1477-0903
DOI:10.1191/0960327104ht478cr