False-Positive Diagnosis of Brain Death Following the Pediatric Guidelines: Case Report and Discussion

• Published in: Journal of child neurology 2017-12, Vol.32 (14), p.1104-1117
• Main Author: Shewmon, D. Alan
• Format: Article
• Language: English
• Subjects: Brain Death - diagnostic imaging; Cerebrovascular Circulation - physiology; Child, Preschool; Diagnostic Errors; Electroencephalography; False Positive Reactions; Humans; Intracranial Pressure; Male; Pentetic Acid - metabolism; Radionuclide Imaging; Time Factors; Tomography, X-Ray Computed
• ISSN: 0883-0738; 1708-8283
• DOI: 10.1177/0883073817736961

A 2-year-old boy with severe head trauma was diagnosed brain dead according to the 2011 Pediatric Guidelines. Computed tomographic (CT) scan showed massive cerebral edema with herniation. Intracranial pressures were extremely high, with cerebral perfusion pressures around 0 for several hours. An apnea test was initially contraindicated; later, one had to be terminated due to oxygen desaturation when the Pco 2 had risen to 57.9 mm Hg. An electroencephalogram (EEG) was probably isoelectric but formally interpreted as equivocal. Tc-99m diethylene-triamine-pentaacetate (DTPA) scintigraphy showed no intracranial blood flow, so brain death was declared. Parents declined organ donation. A few minutes after withdrawal of support, the boy began to breathe spontaneously, so the ventilator was immediately reconnected and the death declaration rescinded. Two hours later, life support was again removed, this time for prognostic reasons; he did not breathe, and death was declared on circulatory-respiratory grounds. Implications regarding the specificity of the guidelines are discussed.