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Pupil for the identification of brain death Akira Fujita 1 , Hitoshi Ishikawa 1 , Iehiko Tsujisawa 1 , Kazuo Mukuno 1 , Satoshi Ishikawa 1 1Dept of Ophthalmol Sch of Med, Kitasato Univ pp.541-543
Published Date 1991/4/15
DOI https://doi.org/10.11477/mf.1410900596
  • Abstract
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The state of the pupil serves as one the indicators of brain death. We evaluated the pupil in 50 cases during the phase of brain death due to stroke, subarachnoid hemorrhage or trauma. The pupil diameter, an measured under illumination at 650 lux, ranged between 4 and 8 mm in 47 cases. We instilled 0.06% pilocarpine in 10 cases. No constric-tion of the pupil resulted before onset of brain death. Miosis, by an average of 41%, was induced in 7 cases, 70%, 21 hours after onset of brain death. In the absence of innervation after brain death, this reaction seemed to be due to cholinergic supersen-sitivity of the pupil. A rapid development of dener-vation supersensitivity seemed to be related to direct pathway from the brainstem to iris sphincter muscle. Three cases responded to 1.25% 1-epine-phrine instillation, suggesting loss of sympathetic innervation. Instillation of low-concentration pilocarpine seemed to be of value in determination of brain death.


Copyright © 1991, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1308 印刷版ISSN 0370-5579 医学書院

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