Brain dead or minimally conscious?

March 26, 2014 (Press-News.org) Major advances in medicine are allowing more people to survive traumatic brain injuries sustained in automobile collisions and other types of serious accidents. A traumatic brain injury (TBI) can occur when an individual suffers oxygen deprivation that causes damage to his or her brain. This deprivation of oxygen may lead to a physician pronouncing a loved one "brain dead." In modern medicine, what exactly does the term brain dead really mean?

Following a brain injury, a patient may be placed in a coma or a state of unconsciousness. A coma allows the brain time to heal and rarely lasts longer than a couple weeks. A patient will generally either regain consciousness or transition into a persistent vegetative state. When in a vegetative state, the brain will often show some minimal signs of consciousness but the patient may not have higher cognitive function and may only be able to open their eyes or make small movements.

The Uniform Determination of Death Act defines brain death as cessation of all functions of the entire brain, including the brain stem. While Illinois has not adopted the UDDA, the Illinois case of In re Haymer held a person is legally dead if he or she sustained "irreversible cessation of total brain function."

A CT Scan, PET Scan and/or MRI are some of the tests frequently used to determine the severity of a brain injury. However, traumatic brain injuries are very complicated and the true prognosis of the injured person may be difficult to determine. Several recent cases show that doctors may incorrectly characterize someone as brain dead who later may recover to some degree.

Miraculous recoveries and research advances

ABC News recently reported on a Bringham Young University freshman who suffered severe brain damage after being hit while riding her long board. According to her family, doctors pronounced her brain dead and gave her "less than a five percent chance of survival." Her family refused to give up hope and she reportedly woke up while the family was singing hymns to her.

Science Daily examines the story of George Melendez who in 2002 ended up in a minimally conscious state following a car accident. His mother, in an attempt to ease his withering and moaning gave him the sleep drug Ambien. To her surprise, her son looked up at her and tried to talk. He is now able communicate using the drug regularly at mealtimes. Researchers studied Melendez and two other patients similarly "awakened" in hopes of finding a way to predict whether patients might harbor reserve brain capacity.

Further examining the effect of Ambien, a team of scientists led by Weill Cornell Medical College used electroencephalography (EEG) brain wave tests of the three patients to discover a common signature of brain activity. Dr. Nicholas Schiff, a senior investigator in this study and Professor of Neurology and Neuroscience at Weill Cornell, estimates that America has about 300,000 patients trapped in minimally conscious states who may retain some awareness. These findings are reported in the November 19, 2013 edition of the journal eLife.

An electric brain stimulation called transcranial direct-current stimulation may also provide benefits to individuals in minimally conscious states. The results of a recent study published in the February 26, 2014 issue of the journal Neurology found clinical improvements in 43 percent of patients in a minimally responsive state. Although some patients had recently suffered their trauma, others had been in a minimally conscious state for years.

Ultimately, the brain is very complex and many of its functions and mechanics are not well understood. While ethical issues surround any decision to discontinue mechanical support, a small number of cases exist where individuals recovered just months after a doctor described the person as 'brain dead.' It is very important to understand the true classification of a person pronounced brain dead. Detailed questions should be asked and proper tests should be performed to determine cognitive function before any final decision is made.

Article provided by Leopold & Associates, L.L.C.
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