Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Brain Abscess Brain Death 249

follow-up

■Imaging studies every 2 wks for 6 months or until contrast enhance-

ment disappears

complications and prognosis

■Mortality depends on condition when effective antibiotics initiated:

5–10% if pt alert, 50% if pt comatose

■Intraventricular rupture has 90% associated mortality

■Persisting contrast enhancement has 20% recurrence rate

■30% of survivors have residual neurologic deficit

Brain Death........................................

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Coma

■Unresponsive to external stimulation (but spinal reflex responses

may occur)

■No brain stem reflex responses: absent pupillary, oculocephalic,

corneal, gag reflexes; no response on cold-caloric testing; no spon-

taneous respiration on apnea test

■No reversible causes of clinical state (eg, temperature exceeds 32C,

no exposure to CNS depressant drugs)

■Clinically stable for at least 6 hr

tests

■Ancillary tests sometimes required to confirm brain death

➣EEG: isoelectric

➣Radionuclide brain scan or cerebral angiography: no cerebral

blood flow

differential diagnosis

■Exclude hypothermia, coma w/ preserved brain stem reflexes or drug

overdose

management

■Discuss w/ family

■Discontinue life support

treatment

■None