Burns Jeffrey M, Login Ivan S
Department of Neurology, University of Virginia Health Sciences Center, Box 800394, Charlottesville, VA 22908, USA.
BMC Neurol. 2002 Jun 26;2:5. doi: 10.1186/1471-2377-2-5.
Brain death is strictly defined medically and legally. This diagnosis depends on three cardinal neurological features: coma, absent brainstem reflexes, and apnea. The diagnosis can only be made, however, in the absence of intoxication, hypothermia, or certain medical illnesses.
A patient with severe hypoxic-ischemic brain injury met the three cardinal neurological features of brain death but concurrent profound hypothyroidism precluded the diagnosis. Our clinical and ethical decisions were further challenged by another facet of this complex case. Although her brain damage indicated a hopeless prognosis, we could not discontinue care based on futility because the only known surrogate was mentally retarded and unable to participate in medical planning.
The presence of certain medical conditions prohibits a diagnosis of brain death, which is a medicolegal diagnosis of death, not a prediction or forecast of future outcome. While prognostication is important in deciding to withdraw care, it is not a component in diagnosing brain death.
脑死亡在医学和法律上有严格定义。该诊断取决于三个主要神经学特征：昏迷、脑干反射消失和呼吸暂停。然而，只有在不存在中毒、体温过低或某些疾病的情况下才能做出该诊断。
一名患有严重缺氧缺血性脑损伤的患者符合脑死亡的三个主要神经学特征，但同时存在的严重甲状腺功能减退症排除了该诊断。这个复杂病例的另一个方面进一步挑战了我们的临床和伦理决策。尽管她的脑损伤表明预后无望，但我们不能基于无意义而停止治疗，因为唯一已知的替代决策者智力迟钝，无法参与医疗规划。
某些疾病的存在禁止做出脑死亡诊断，脑死亡是一种法医学上的死亡诊断，而非对未来结果的预测。虽然预后评估在决定停止治疗时很重要，但它不是脑死亡诊断的一个组成部分。
