An elusive brain death diagnosis: You can't get there from here.

Abstract

I read with great interest the case report by Story and Winter.1 Their patient was brain dead clinically but confirmatory testing in the form of CT angiography and EEG was requested, which failed to document whole-brain death. One might argue that they would not have encountered this medical, ethical, and legal quandary if the concept of brain stem death was adopted and accepted universally as opposed to whole-brain death, which is the currently accepted criterion in the United States. Electrocerebral inactivity or electrocerebral silence in a brain death EEG is defined as no EEG activity over 2 uV when recording from scalp electrode pairs 10 or more cm apart with interelectrode impedances under 10,000 Ohms (10 KOhms) but over 100 Ohms. It is a well-known fact that pockets of brain activity may persist in a patient who is clinically (all brain stem reflexes absent and apnea test positive) brain dead. These islands of brain activity may yield a …