孤立性脳幹死と鑑別が困難であった最重症脳幹障害（疑似脳幹死）の１例

Abstract

Electroencephalography is required to make a diagnosis of brain death in Japan, and thus it is possible to differentiate brain stem death from brain death. Brain stem death has been recognized as a transient stage leading to total brain death. However, some authors have insisted that brain stem death has a different etiology from brain death. Brain stem death occurs under restricted conditions, such as when intracranial pressure is controlled, and supratentorial cerebral ischemia is prevented. An apnea test, in which breathing is assessed objectively by visual inspection of chest movement, must be performed to diagnose brain death. Here we report a case of spontaneous breathing detected using a spirometer in spite of brain death criteria being almost completely satisfied. A 68-year-old male was admitted with sudden onset of coma. A computed tomography (CT) scan revealed a large cerebellar hematoma and acute hydrocephalus. Bilateral ventricular drainage and barbiturate therapy were performed, however, since intracranial pressure was maintained under 20mmHg, the patient failed to meet the criteria for comatose on the Japan Coma Scale 300. The authors examined the patient for brain death 8 times before he was pronounced dead on day 137. The EEG was positive until day 45 and the atropine test was positive throughout. Moreover, even though brain death criteria were satisfied on day 117, spontaneous breathing was detected using a spirometer.