A slight return, again

I’ve just found another curious case report of complex movements in a brain dead patient, following on from our recent piece on the Lazurus Sign.

These reports are fascinating and bizarre in equal measure, not least when you try and imagine what was happening in the room at the time.

Uncommon reflex automatisms after brain death

Rev Neurol (Paris). 1995 Oct;151(10):586-8.

Awada A.

Two cases of unusual complex movements observed in brain dead patients are described. Rapid and sustained flexion of the neck induced slow abduction of the arms with flexion of the elbows, wrists and fingers over 5 to 10 seconds. These movements have been rarely described and although they have similar clinical patterns, they are pathophysiologically different from the Lazarus sign which is observed few minutes after respiratory support cessation. While Lazarus sign is supposed to be due to an agonal discharge of anoxic spinal neurons, the movements described in this article result probably from complex reflexes generated in a disinhibited spinal cord. It is however surprising that they have never been described in patients with high cervical spinal injuries.

For those of you not familiar with the medical terms for movement, I shall briefly translate. When the doctors rocked the dead person’s head side to side forward in a ‘rapid and sustained’ fashion, the body extended its arms to the side and waved them about.

I have two thoughts.

Firstly, isn’t it fascinating that such complex movements can be triggered solely by the spinal cord?

Secondly, what the bloody hell were they doing with that dead body?

Normally, these reports are of spontaneous movements in isolated brain dead patients, but on this occasion the medical team seem to have been rather more involved.

Unfortunately, the full text of the article is in French, so the exact turn of events (e.g. “hey looks what happens when I do this!”) shall have to remain a mystery.

UPDATE: Neuroshrink has added a fantastic correction and comment to this post that suggests what might have been happening and recounts his own experience of observing the Lazurus sign.

Link to PubMed entry for article.
Link to Mind Hacks on the Lazurus Sign.
Link to another Mind Hacks article on the moving dead.

One Comment

  1. neuroshrink
    Posted November 1, 2008 at 3:40 am | Permalink

    Actually, the movement described in the paper is pulling the head forward (chin toward chest) and holding it there. I’m not sure why they were doing that, although perhaps it was during transport of the body.
    One common test for brainstem reflexes vs. cortical function, however, is the movement you described: turning the head back and forth looking for fixation of gaze (“doll’s eyes”). That’s a common test while establishing the presence of brain death. I haven’t looked at the paper (and don’t read French) so I’m not sure at what phase of death the movements were seen, but perhaps it was during an exam of this kind.
    An instance of Lazarus sign I saw was during an apnea test to establish brain death. The ventilator is shut off, and if there is no spontaneous respiration when the pCO2 rises above 60mmhg, the test is “positive” (consistent with brain death). Anyway, I saw a patient who was apneic, but when the ventilator tube was disconnected for the test he flexed at hips and elbows, which looked like he sat up and reached for the endotracheal tube. This freaked out the respiratory therapist, and he quickly reconnected the ventilator until we figured out what had happened and repeated the test. The patient was in fact brain dead.


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