A 31-YEAR-OLD man underwent an operation for a right acoustic nerve schwannoma complicated by a massive brainstem hemorrhage. Results of postoperative computed tomography revealed widespread hemorrhagic lesions in the brainstem accompanied by hemorrhage in the adjacent subarachnoid space and massive edema of the posterior fossa (Figure 1). The patient's neurological condition deteriorated with progressive loss of brainstem functions. Neurologic evaluation 36 hours after surgery revealed loss of all brainstem reflexes including eye movements, response to caloric stimulation, and spontaneous respiration. There was no motor response to painful stimuli and no vestibulo-ocular reflexes. Treatment with medication had already been discontinued for 24 hours, and body temperature was 36°C.
Zwarts MJ, Kornips FHM, Vogels OM. Clinical Brainstem Death With Preserved Electroencephalographic Activity and Visual Evoked Response. Arch Neurol. 2001;58(6):1010. doi:10.1001/archneur.58.6.1010