Manara Alex, Varelas Panayiotis, Smith Martin
The Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
Department of Neurology, Henry Ford Hospital, Detroit, MI, USA.
J Intensive Care Soc. 2020 Aug;21(3):269-273. doi: 10.1177/1751143719832169. Epub 2019 Mar 7.
The neurological determination of death in patients with isolated brainstem lesions or by disruption of the posterior cerebral circulation is uncommon and many intensivists may never see such a case in their career. It is also the only major difference between the "whole brain" and "brain stem" formulations for the neurological determination of death. We present a case of a patient with infarction of the structures supplied by the posterior cerebral circulation in whom death was diagnosed using neurological criteria, to illustrate the issues involved. We also suggest that international consensus may be achieved if ancillary tests, such as CT angiography, are made mandatory in this situation o demonstrate loss of blood flow in the anterior cerebral circulation as well the posterior circulation.
孤立性脑干病变患者或因大脑后循环中断导致神经学判定死亡的情况并不常见，许多重症监护医生在其职业生涯中可能从未见过这样的病例。这也是“全脑”和“脑干”两种神经学判定死亡标准之间唯一的主要区别。我们报告一例大脑后循环供血结构梗死的患者，该患者依据神经学标准被判定死亡，以此说明其中涉及的问题。我们还建议，如果在这种情况下强制进行诸如CT血管造影等辅助检查，以证明前循环和后循环均无血流，或许可以达成国际共识。
