PubMed · 5537243
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H Baruk. 1970. [Brain and mind].. https://pubmed.ncbi.nlm.nih.gov/5537243/
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Regular ophthalmic surveillance started in 1982 for all surviving prematures in Frederiksborg County considered at risk of developing retinopathy of prematurity (ROP). During 1982-1984 185 infants of gestational age 25-35 weeks at delivery were examined; blindness eventually appeared in four out of the 28 who showed some stage of ROP. All 28 attended ophthalmic reassessment at age 7-10 years and were compared with 60 of the same cohort without evidence of ROP. At follow-up (n = 88) there was evidence of psychomotor disturbances in 45 children, manifesting as major CNS damage in 21, and minor in 24. With correction for drop-outs the regional frequency of severe CNS damage (mainly cerebral palsy and mental retardation) was 29.6% for gestational ages < 32 weeks at delivery and 24% as calculated for birth weights < 1500 g. An analysis of perinatal factors based mainly on matched pairs did not indicate any definite association with subsequent damage to eye or brain, and statistically there was no association between severity of ROP and CNS impairment. We have no explanation for the high frequency of CNS impairment at follow-up.
We report on a patient who suffered an acute, extensive intracerebral haemorrhage, leading to symptoms of cerebral herniation within a few hours. The clinical diagnosis of brain death was made based on a neurological examination, and an apnoea test eight hours after the haemorrhage. A few hours later the diagnosis was changed, as several reflexes reappeared. After six days mechanical ventilation was withdrawn, as the brain damage was considered so serious as to render further therapy futile. It was considered unethical to sustain therapy for a possible organ donation at a later date. A review of relevant the literature, however, shows that brain-dead patients may exhibit such varying degrees of autonomic and spinal reflexes as to cause confusion, thus delaying the physician in making a diagnosis. Often, an opportunity for organ donation is lost. Based on this review, we believe that our patient was indeed brain dead when the first diagnosis was made, and that a cerebral angiography should have been performed. Because organ donation is an important issue, the diagnosis of brain death must be definitive.