Pediatrics and Neurology, 12222David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Section of Neuroradiology, 12222David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
J Child Neurol. 2022 Jan;37(1):35-42. doi: 10.1177/08830738211035871. Epub 2021 Nov 23.
Jahi McMath was diagnosed brain dead on 12/12/2013 in strict accordance with both the pediatric and adult Guidelines, reinforced by 4 isoelectric electroencephalograms and a radionuclide scan showing intracranial circulatory arrest. Her magnetic resonance imaging scan 9 1/2 months later surprisingly showed gross integrity of cortex, basal ganglia, thalamus, and upper brainstem. The greatest damage was in the white matter, which was extensively demyelinated and cystic, and in the lower brainstem, most likely from partial herniation that resolved. The apparent integrity of gray matter and the ascending reticular activating system may have provided a potential structural basis for the reemergence of some limited brain functions, while the white matter and lower brainstem lesions would have caused severe motor disability, brainstem areflexia and apnea. The findings indicate that there could never have been a period of sustained intracranial circulatory arrest. Rather, at the time of brain death diagnosis, low blood flow below the detection threshold of the radionuclide scan was sufficient to maintain widespread neuronal viability, though insufficient to support synaptic function. Her case represents the first indirect confirmation of the reality and clinical relevance of global ischemic penumbra, hypothesized in 1999 as a generally unacknowledged and possibly common brain death mimic.
杰希·麦克马思于 2013 年 12 月 12 日被诊断为脑死亡，严格符合儿科和成人指南，4 次等电脑电图和放射性核素扫描显示颅内循环停止得到了强化。她的磁共振成像扫描 9 个半月后令人惊讶地显示出皮质、基底节、丘脑和上脑干的大体完整性。最大的损伤发生在白质，广泛脱髓鞘和囊性，以及在下脑干，很可能来自部分疝，已经解决。灰质和上行网状激活系统的明显完整性可能为一些有限的脑功能重新出现提供了潜在的结构基础，而白质和下脑干病变会导致严重的运动障碍、脑干反射消失和呼吸暂停。这些发现表明，不可能存在持续的颅内循环停止。相反，在脑死亡诊断时，放射性核素扫描检测阈值以下的低血流量足以维持广泛的神经元活力，尽管不足以支持突触功能。她的病例代表了对全球缺血半影区的现实和临床相关性的首次间接证实，该理论于 1999 年提出，被认为是一种普遍未被承认且可能常见的脑死亡模拟。
