The recommended1-4 criteria for diagnosing cerebral death are electrocerebral silence (ECS) in an EEG performed in conformance with rigorous requirements outlined by the American Electroencephalographic Society5 and supportive clinical correlates, including absence of spontaneous ventilation and other spontaneous movements and total absence of brainstem-mediated reflexes. The patient must not be hypothermic or have drug-induced central depression.
A meticulous survey of 1,665 patients reported to have ECS found recovery in only three patients who were suffering from drug overdose.2 Two other patients with ECS maintained or regained effective spontaneous ventilation, coordinated movements, and reflex activities at the brainstem and spinal cord levels.6 Both survived for five months. Presumably, the EEG conformed to the criteria mentioned above. To our knowledge, there are no other well-documented reports of unambiguous ECS in adult patients who maintained spontaneous ventilation as the only brainstem function for any length of time.
Boutros AR, Henry CE. Electrocerebral Silence Associated With Adequate Spontaneous Ventilation in a Case of Fat Embolism: A Clinical and Medicolegal Dilemma. Arch Neurol. 1982;39(5):314–316. doi:10.1001/archneur.1982.00510170056018
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