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April 18, 1986

Spontaneous Movements in Brain-Dead Patients-Reply

Author Affiliations

University of Rochester School of Medicine Rochester, NY

JAMA. 1986;255(15):2028. doi:10.1001/jama.1986.03370150070028

In Reply.—  Patients who are brain dead often have unusual spontaneous movements when they are disconnected from their ventilators. Numerous authors1-3 have described these disconcerting phenomena.Patients who fulfill all the criteria for death, including deep unresponsive coma, fixed unreactive pupils, absent oculovestibular response, absent corneal reflexes, apnea with Pco2 level greater than 50 mm Hg, and electrocortical silence for 30 minutes or longer, may experience any of the following: goose bumps, shivering, extensor movements of the arms, rapid flexion of the elbows, elevation of the arms above the bed, crossing of the hands, reaching of the hands toward the neck, forced exhalation, and thoracic respiratory-like movements. In addition, flexing the neck (for example, when a parent holds his dying child) may elicit a Moro-like myoclonic response. These complex sequential movements are felt to be release phenomena from the spinal cord including the upper cervical cord and do not