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Minerva Anestesiologica 2019 July;85(7):774-81

DOI: 10.23736/S0375-9393.19.13338-X

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Death by neurologic criteria: pathophysiology, definition, diagnostic criteria and tests

Chiara ROBBA ¹, Carolina IAQUANIELLO ², Giuseppe CITERIO ^{2, 3} ✉

¹ Department of Anesthesia and Intensive Care, IRRCS for Oncology, University of Genoa, Genoa, Italy; ² School of Medicine and Surgery, University of Milan-Bicocca, Monza, Monza-Brianza, Italy; ³ Unit of Neurointensive Care, San Gerardo Hospital, ASST-Monza, Monza-Brianza, Italy

Death by neurologic criteria is an irreversible sequence of events culminating in permanent cessation of cerebral functions. In this context, there are no responses arising from the brain, no cranial nerve reflexes nor motor responses to pain stimuli, and no respiratory drive. The diagnosis of death by neurologic criteria implies that there is clinical evidence of the complete and irreversible cessation of brainstem and cerebral functions. The diagnosis, confirmation, and certification of death are core skills for medical practitioners. The aim of this review is to discuss the pathophysiology and definition of death by neurological criteria, describing the clinical assessment, and the use of ancillary tests for the diagnosis of brainstem death.

KEY WORDS: Brain death; Critical care; Neurologic examination; Reflex, pupillary