Working Paper Review Version 2 This version is not peer-reviewed

Brain Death Diagnosis in Primary Posterior Fossa Lesions

Version 1 : Received: 18 March 2020 / Approved: 23 March 2020 / Online: 23 March 2020 (05:43:44 CET)
Version 2 : Received: 2 August 2020 / Approved: 3 August 2020 / Online: 3 August 2020 (01:22:49 CEST)

How to cite: Machado, C. Brain Death Diagnosis in Primary Posterior Fossa Lesions. Preprints 2020, 2020030335 Machado, C. Brain Death Diagnosis in Primary Posterior Fossa Lesions. Preprints 2020, 2020030335


Background: New controversies have raised on brain death (BD) diagnosis when lesions are localized in the posterior fossa. Objective: To discuss the particularities of diagnosis BD in patients with posterior fossa lesions. Material and Methods. The author made a systematic review of literature on this topic. Results and Conclusions: A supratentorial brain lesion usually produces a rostrocaudal transtentorial brain herniation, resulting in forebrain and brainstem loss of function. In secondary brain lesions [i.e., cerebral hypoxia], the brainstem is also affected like the forebrain. Nevertheless, some cases complaining posterior fossa lesions [i.e., basilar artery thrombotic infarcts, or hemorrhages of the brainstem and/or cerebellum] may retain intracranial blood flow and EEG activity. In this article I discuss that if a posterior fossa lesion does not produce an enormous increment of intracranial pressure, a complete intracranial circulatory arrest does not occur, explaining the preservation of EEG activity, evoked potentials, and autonomic function. I also address Jahi McMath, who was declared braindead, but ancillary tests, performed 9 months after initial brain insult, showed conservation of intracranial structures, EEG activity, and autonomic reactivity to “Mother Talks” stimulus, rejecting the diagnosis of BD. Jahi McMath’s MRI study demonstrated a huge lesion in the pons. Some authors have argued that in patients with primary brainstem lesions it might be possible to find a in some cases partial recover of consciousness, even fulfilling clinical BD criteria. This was the case in Jahi McMath.


Brain death; posterior fossa; brainstem death; ancillary tests; EEG; evoked potentials


Medicine and Pharmacology, Neuroscience and Neurology

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Comment 1
Received: 3 August 2020
Commenter: Calixto Machado
Commenter's Conflict of Interests: Author
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