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LAZARUS' SIGN AND RESPIRATORY-LIKE MOVEMENT IN A PATIENT OF BRAIN DEATH Ei-ichirou Urasaki 1,4 , Akinobu Fukumura 1 , Yoshihiro Itho 1 , Youichi Itoyama 1 , Masaharu Yamada 1 , Yukitaka Ushio 2 , Shin-ichi Wada 3 , Akira Yokota 3 1Department of Neurosurgery, Shimonoseki Kosei Hospital 2Department of Neurosurgery, Kumamoto University Medical School 3Department of Neurosurgery, University of Occupational and Environmental Health 4Present Address: Department of Neurosurgery, University of Occupational and Environmental Health pp.1111-1116
Published Date 1988/12/1
DOI https://doi.org/10.11477/mf.1406206215
  • Abstract
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In the diagnosis of brain death, it is generally accepted that respiratory function has to be absent, however, spinal reflexes can be preserved. Wepresented a patient who showed a complex move-ments of upper limbs (Lazarus' sign) and res-piratory like movement during the apnea test for the determination of brain death. This 72-year old female admitted to our hospital in a semi-comatous state due to severe subarachnoid and ventricular hemorrhage. Her conscious level sud-denly deteriorated to deep coma because of second hemorrhage on the same day. She became apnea and no brain stem reflexes elicited. Three days later, electrophysiological examination revealed a flat recording of electroencephalography, absence of auditory evoked potentials and no response of blink reflex. Short latency somatosensory evoked potentials obtained by median nerve stimulation showed the presence of Erb's N9 and spinal N 13-P 13 components originating from cervical dorsal horn, however, the scalp P 13 generated by cervico-medullary junction was absent. This patient fulfilled all other criteria for brain death. Four days after, an apnea test was performed. Spontaneous movements of both upper limbs wereobserved starting between 7 and 8 minutes after disconnecting the intubation tube from the venti-lator. Both arms flexed at the elbow, abducted and elevated from the bed. Then, both hands were brought up to chest. Wrist and fingers were in a neutral position (Lazarus' sign). Simultaneous-ly, shallow and irregular respiration like move-ments were recognized. These movements ceased immediately after connecting the respirator. These two types of movements were reproducible except for in the final test. Blood pressure gradually decreased, and cardiac arrest occurred one hour after. The mechanism of Lazarus' sign and res-piratory like movements were discussed. SSEP findings suggested that these movements were ori-ginated from spinal level rather than brain stem. It was considered that they were elicited by the spinal reflexes induced by hypoxia, hypercapnia or other metabolic factors during apnea. Atten-tion has to be paid that such complex spinal re-flexes could appear in the condition of brain death.


Copyright © 1988, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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