Ishiguro T, Tamagawa S, Ogawa H
Department of Psychiatry, Jichi Medical School.
Seishin Shinkeigaku Zasshi. 1992;94(9):864-73.
The representative criteria of brain death in Japan is Takeuchi Criteria (Koseisho Criteria), which is the definition of irreversible loss of brain function (functional brain death). The 3rd item of that criteria is "fixed pupil" and pupil size more than 4 mm. The 4th item is loss of the brain nerve reflexes including the light reflex. Three cases of brain death by whole brain destruction (organic brain death) who showed slow changes of pupil size were reported. Except fixed pupil, one case fulfilled Takeuchi Criteria. Other two cases fulfilled all items of Takeuchi Criteria, showing the same pupil size accidentally at the first and the second judgements. But, they changed their pupil size slowly and continuously after the examinations, showing tendencies toward mydriasis and/or miosis, repeatedly. They never decreased their pupil size less than 4 mm. The changes of pupil size were so slow that we could recognize them only after several hours or several days, and they were quite different from the light reflex. They did not receive any influences from turnover of day and night, darkness of the room, dopamine, etc. For the changes of pupil size were observed in the cases of organic brain death, it was elucidated that they were not due to the brain nerve activity. Then, it was considered that the changes of pupil size in the cases of functional brain death should be the same phenomena, because brain nerve function was lost.(ABSTRACT TRUNCATED AT 250 WORDS)
日本脑死亡的代表性标准是竹内标准（厚生省标准），即脑功能不可逆丧失（功能性脑死亡）的定义。该标准的第3项是“固定瞳孔”且瞳孔直径大于4毫米。第4项是包括光反射在内的脑神经反射消失。报告了3例因全脑破坏（器质性脑死亡）导致脑死亡且瞳孔大小缓慢变化的病例。除固定瞳孔外，1例符合竹内标准。另外2例符合竹内标准的所有项目，在首次和第二次判断时意外地显示相同的瞳孔大小。但是，检查后它们的瞳孔大小缓慢且持续变化，反复出现瞳孔散大或缩小的趋势。它们的瞳孔大小从未减小到4毫米以下。瞳孔大小的变化非常缓慢，以至于我们只能在数小时或数天后才能识别，而且与光反射有很大不同。它们不受昼夜交替、房间黑暗程度、多巴胺等的影响。由于在器质性脑死亡病例中观察到了瞳孔大小的变化，因此可以明确这些变化并非由于脑神经活动引起。那么，可以认为功能性脑死亡病例中的瞳孔大小变化应该是相同的现象，因为脑神经功能已经丧失。（摘要截断于250字）
