To the Editor. —
The article by Field et al1 is a technical feat demonstrating medicine's abilities to provide prolonged life support in a brain dead individual. A 27-year-old woman was kept alive for 9 weeks to allow fetal maturation of a 22-week pregnancy after having suffered brain death. She presented with a 5-day history of headaches, vomiting, and disorientation. Vital signs were normal. A lumbar puncture was performed; 4 hours later she had a generalized seizure, respiratory arrest, and was then brain dead.Her $217 784 hospital bill could have been substantially less if a computed tomographic (CT) scan (at a cost of $300 to $500) had been obtained prior to the lumbar puncture. It does not matter whether the scan would have been done with or without contrast (or both), as the obstructive hydrocephalus would have been recognized easily and subsequent brain herniation prevented.The only possible
Bremer HL. Maternal Brain Death During Pregnancy. JAMA. 1989;261(12):1729. doi:10.1001/jama.1989.03420120060017
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