Journal ArticleDOI
Fulminant acute inflammatory demyelinating polyradiculoneuropathy: case report and literature review.
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TLDR
The oculocardiac response may be a useful addition to the routine examination in patients who are suspected of being cerebrally dead or of having absent brainstem function, especially in cases where a central lesion or underlying disease is not evident to explain the condition.Abstract:
Background: The inflammatory polyradiculoneuropathies (Guillain-Barre Syndrome) represent a diverse spectrum of diseases, with variable pathophysiological mechanisms (demyelinating versus axonal), clinical manifestations (motor, sensory, and autonomic), presentation patterns, and degrees of severity. Fulminant cases of total body paralysis with loss of all cranial nerve reflexes have been described, whereby patients appear to have lost all central nervous system (CNS) function. Methods: The case of a patient with a fulminant polyradiculoneuropathy in whom consideration was given to discontinuation of care and organ donation is presented. A positive oculocardiac response verified ongoing brainstem function and led to the diagnosis of an inflammatory polyradiculoneuropathy. The patient was successfully treated with plasmapheresis and intravenous immunoglobulins. Conclusion: The oculocardiac response may be a useful addition to the routine examination in patients who are suspected of being cerebrally dead or of having absent brainstem function, especially in cases where a central lesion or underlying disease is not evident to explain the condition. Additional study and validation of the oculocardiac response in these situations is proposed.read more
Citations
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Journal ArticleDOI
Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project.
David M. Greer,Sam D. Shemie,Sam D. Shemie,Ariane Lewis,Sylvia Torrance,Panayiotis N. Varelas,Fernando D. Goldenberg,James L. Bernat,Michael J. Souter,Mehmet Akif Topcuoglu,Anne W. Alexandrov,Marie R. Baldisseri,Thomas P. Bleck,Giuseppe Citerio,Rosanne Dawson,Arnold Hoppe,Stephen Jacobe,Alex Manara,Thomas A. Nakagawa,Thaddeus Mason Pope,William Silvester,David Thomson,Hussain N. Al Rahma,Rafael Badenes,Andrew J. Baker,Vladimir Cerny,Cherylee Chang,Tiffany R. Chang,Elena Gnedovskaya,Moon Ku Han,Stephen Honeybul,Edgar Jimenez,Yasuhiro Kuroda,Gang Liu,Uzzwal Kumar Mallick,Victoria Marquevich,Jorge Mejia-Mantilla,Michael A. Piradov,Sarah Quayyum,Gentle Sunder Shrestha,Ying Ying Su,Shelly D. Timmons,Jeanne Teitelbaum,Walter Videtta,Kapil Zirpe,Gene Sung +45 more
TL;DR: Recommendations are provided for the minimum clinical standards for determination of brain death/death by neurologic criteria in adults and children with clear guidance for various clinical circumstances and have widespread international society endorsement.
Journal Article
Clinical Approach to the Weak Patient in the Intensive Care Unit
TL;DR: Motor weakness in a patient in the intensive care unit (ICU) may be related to (1) pre-existing neuromuscular disorder that leads to ICU admission, (2) new-onset or previously undiagnosed neurological disorder, or (3) complications of non-neuromUScular critical illness.
Journal ArticleDOI
Weakness on the intensive care unit
TL;DR: It is essential to undertake a meticulous review, including assessment of any septic, hypoxic or metabolic derangements and a detailed look at the dosage and duration of medication including antibiotics, neuromuscular junction blocking agents and sedation.
Journal ArticleDOI
Guillain-Barré syndrome mimicking brain death.
TL;DR: Fulminant Guillain–Barré syndrome (GBS) is a rapidly progressive variant of acute inflammatory polyradiculoneuropathy in which the patient develops flaccid quadriplegia and loss of brainstem function.
Journal ArticleDOI
Brain death: a clinical overview
TL;DR: A review of the philosophy and history of brain death, its clinical determination, and special considerations is given in this article , where the main clinical components of the brain death exam: assessment of coma, cranial nerves, motor testing, and apnea testing.
References
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Journal ArticleDOI
Guillain-Barré syndrome
TL;DR: Investigators of large, worldwide, collaborative studies of the spectrum of Guillain-Barré syndrome are accruing data for clinical and biological databases to inform the development of outcome predictors and disease biomarkers, which is transforming the clinical and scientific landscape of acute autoimmune neuropathies.
Journal ArticleDOI
The Guillain-Barré syndrome.
TL;DR: Several clinical variants of this demyelinating polyneuropathy have been described, the electrophysiologic aspects better understood, and the immunologic basis clarified, but the diagnosis is still made by clinical acumen and experience.
Book
DeJong's The neurologic examination.
TL;DR: This 7th edition of Dejong's The Neurological Examination offers practitioners and residents of Neurology an in-depth discussion of neurologic exams that will not be found anywhere else.
Journal ArticleDOI
Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex.
TL;DR: All patients undergoing maxillofacial procedures should be monitored carefully for reflex bradycardia and ventricular asystole and alternative afferent pathways must exist via the maxillary and/or mandibular divisions.