Abstract
Brain death is diagnosed in the minority of patients with acute severe brain injury.
Guidelines have been developed in many countries in the world and physicians usually
work through a set of criteria. The clinical evaluation starts with determination
of futility of any medical or surgical intervention and an unmistakable certainty
that the underlying diagnosis is correct. The actual neurologic evaluation in a patient
suspected of being brain dead requires 25 tests and verifications. Brain death determination
demands perfect diagnostic accuracy and thus requires skill and expertise. The overriding
principle is simple: establish cause, exclude confounders, determine futility of interventions,
examine brainstem reflexes, and test for apnea. In this review, the author revisits
the American Academy of Neurology guidelines, and examines the details behind the
guidelines. The 2010 guidelines have eliminated unnecessary tests and observation
delays, and maintain a principle of simplicity.
Keywords
brain death - coma - guideline - neurologic examination - intensive care unit
