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This Article Figures Only Full Text Full Text (PDF) Take the CME quiz CME: Take the course for this article: Volume 70, Number 15, April 8, 2008 All Versions of this Article: 01.wnl.0000289762.50376.b6v1 70/15/1234    most recent Correspondence: Submit a response Correspondence: View responses Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wijdicks, E. F.M. Articles by Pfeifer, E. A. Search for Related Content PubMed PubMed Citation Articles by Wijdicks, E. F.M. Articles by Pfeifer, E. A. Related Collections Brain death

Neuropathology of brain death in the modern transplant era

From the Division of Critical Care Neurology (E.F.M.W.) and Department of Anatomic Pathology (E.A.P.), Mayo Clinic College of Medicine, Rochester, MN.

Address correspondence and reprint requests to Dr. Eelco F.M. Wijdicks, Mayo Clinic College of Medicine, Department of Neurology and Division of Critical Care Neurology, 200 First Street SW, Rochester, MN 55905 wijde{at}mayo.edu

Background: Autopsy studies in patients who have been declared brain dead are rare. Total brain necrosis ("respirator brain") has been a common finding in the distant past. The time to brain fixation has been shortened as a result of timely organ transplant protocols, therefore the neuropathologic findings may be different than previously described.

Methods: We reviewed macroscopic and microscopic brain pathology for ischemic neuronal damage in 41 patients who fulfilled the clinical criteria of brain death. Hematoxylin and eosin stained brain tissue slides were retrieved and available wet tissue was additionally stained to complete a series of samples of the hemispheres, brainstem, and cerebellum for each patient. Neuronal ischemic change was semiquantitatively graded for severity (mild 0 to 5%, moderate >5 to 75%, and severe >75%).

Results: After the clinical diagnosis of brain death and terminal cardiac arrest, 12 brains were fixated in less than 12 hours and 29 brains were fixated between 12 and 36 hours. The frontal lobe, temporal lobe, parietal lobe, occipital lobe, and basal ganglia showed moderate to severe ischemic change in 53 to 68% of the cases. Moderate to severe neuronal ischemic change was found in the thalamus in 34%, midbrain in 37%, pons in 41%, medulla in 40%, and cerebellum in 52% of the cases.

Conclusions: No distinctive neuropathologic features were apparent in our series of patients with brain death. Neuronal ischemic changes were frequently profound, but mild changes were present in a third of the examined hemispheres and in half of the brainstems. Respirator brain with extensive ischemic neuronal loss and tissue fragmentation was not observed. Neuropathologic examination is therefore not diagnostic of brain death.

Abbreviations: ICH = intracerebral hemorrhage; SAH = subarachnoid hemorrhage.

Editorial, page 1230

e-Pub ahead of print on February 6, 2008, at www.neurology.org.

Disclosure: The authors report no conflicts of interest.

Received April 25, 2007. Accepted in final form August 27, 2007.

Correspondence: