Electroencephalographic activity after brain death

M. M. Grigg, M. A. Kelly, G. G. Celesia, M. W. Ghobrial and E. R. Ross

Fifty-six consecutive patients clinically diagnosed as brain dead were seen at Loyola University Medical Center, Maywood, Ill, from January 1984 through May 1986. Eleven (19.6%) of the 56 patients had electroencephalographic (EEG) activity following the diagnosis of brain death. The mean duration of the observed EEG activity was 36.6 hours (range, two to 168 hours). Three patterns of EEG activity were observed: (1) low-voltage (4 to 20 microV) theta or beta activity was recorded in nine (16.1%) patients as long as 72 hours following brain death. Neuropathologic studies in one patient showed hypoxic-ischemic neuronal changes involving all cell layers of the cerebral cortex, basal ganglia, brain stem, and cerebellum; (2) sleep-like activity (a mixture of synchronous 30 to 40 microV theta and delta activity and 60 to 80 microV, 10 to 12 Hz spindle-like potentials) was noted in two (3.6%) patients for as long as 168 hours following brain death. Pathologic studies in both cases demonstrated ischemic necrosis of the brain stem with relative preservation of the cerebral cortex; and (3) alpha-like activity (monotonous, unreactive, anteriorly predominant, 25 to 40 microV, 9 to 12 Hz activity) was observed in one (1.8%) patient three hours following brain death. Regardless of activity on the EEG, none of the patients recovered. The occurrence of EEG activity following brain death would suggest reliance on the EEG to confirm brain death may be unwarranted. The use of the EEG as a confirmatory test of brain death may be of questionable value.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Brain Death: Understanding of the Conceptual Basis by Pediatric Intensivists in Canada
Joffe and Anton
Arch Pediatr Adolesc Med 2006;160:747-752.
ABSTRACT | FULL TEXT  

Brief review: The role of ancillary tests in the neurological determination of death: [Revue sommaire : le role des tests accessoires dans la determination neurologique de la mort].
Young et al.
Canadian J. Anesthesia 2006;53:620-627.
ABSTRACT | FULL TEXT  

The Whole-Brain Concept of Death Remains Optimum Public Policy
Bernat
J Law Med Ethics 2006;34:35-43.
 

Difficulty in brainstem death testing in the presence of high spinal cord injury
Waters et al.
Br J Anaesth 2004;92:760-764.
ABSTRACT | FULL TEXT  

Brain death: resolving inconsistencies in the ethical declaration of death: [La mort cerebrale : resoudre les contradictions de la declaration ethique de la mort]
Doig and Burgess
Canadian J. Anesthesia 2003;50:725-731.
ABSTRACT | FULL TEXT  

Determination of Death by Neurological Criteria
Morenski et al.
J Intensive Care Med 2003;18:211-221.
ABSTRACT  

Brain death
Elliot
Trauma 2003;5:23-42.
ABSTRACT  

Diffusion-Weighted Magnetic Resonance Imaging in Brain Death
Lovblad and Basssetti
Stroke 2000;31:539-542.
ABSTRACT | FULL TEXT  

Can Pediatricians Define and Apply the Concept of Brain Death?
Harrison and Botkin
Pediatrics 1999;103:82e-82.
ABSTRACT | FULL TEXT  

Management of the Organ Donor
Abel and Bronheim
SEMIN CARDIOTHORAC VASC ANESTH 1998;2:100-105.
ABSTRACT  

Analytic Reviews : Organ Procurement and Brain Death in Trauma Patients
Mackersie
J Intensive Care Med 1989;4:137-148.
ABSTRACT