Family wants to keep life support for girl brain dead after tonsil surgery #8

[PMLsmom]

I wish I could see that whole report on the details. That is almost unbelievable.

eta: here's the full report

http://www.hods.org/pdf/Long Survival Following Baterial Meningits-Associated Brain Destruction1.pdf

Thanks BL - Now, where are our WS Med. Experts? I would LOVE to hear their take on this (where us laypeople can understand lol)...TIA to our specialist peeps.

 

[forthelost]

Thanks BL - Now, where are our WS Med. Experts? I would LOVE to hear their take on this (where us laypeople can understand lol)...TIA to our specialist peeps.

He didn't really have a brain anymore, just a hard shell with gunk in it.

edit: The report has pictures of it. It's not pretty.

 

[AnonymousD]

He didn't really have a brain anymore, just a hard shell with gunk in it.

edit: The report has pictures of it. It's not pretty.

Thanks, forthelost.

 

[kaki]

This boy was brain dead for 20 years after a CNS infection, so Jahi won't be making any records for a while yet.

http://www.ncbi.nlm.nih.gov/pubmed/16970850

Wow! So it is possible for Jahi to be maintained on the ventilator for years! :banghead:

I wonder why this boy was maintained for so long on the ventilator once they knew he was braindead. Scary!

 

[al66pine]

Yes, PML, where are our med professionals to advise on link?

"ABSTRACT
This report describes the brain autopsy of a boy who at age 4 1/2

​

​

years experienced an episode of fulminant Haemophilus influenzae type b bacterial meningitis, resulting in

massive brain destruction and the clinical signs of brain death.

However, medical intervention maintained him for an additional two decades....
This case represents an example of long survival of brain death with a living body. ​

(J Child Neurol 2006;21:591–595; DOI 10.2310/7010.2006.00137).

at page 2

"...he was ventilator dependent. Reflex responses of the limbs and trunk to tactile stimuli
consisting of nonpurposeful muscular movements were noted, along with ​

occasional apparently spontaneous limb movements...."

​

​

​

​

​

​

at page 2.

"...Median nerve somatosensory evoked potentials were recorded following stimulation of both the right and left sides,
with normal values for the median nerve conduction velocity

(right 68.3 milliseconds left 66.6 milliseconds, N13 latency (right 11.04 milliseconds; left 10.88 milliseconds),

and P14 latency (right 11.68 milliseconds; left 11.60 milliseconds);​

no N18 or N20 responses could be elicited...." BBM SBM
http://www.hods.org/pdf/Long%20Survival%20Following%20Baterial%20Meningits-Associated%20Brain%20Destruction1.pdf​

Does anyone read ^this^ as a finding inconsistent w brain death?

If so, then he had all clinical signs of brain death, but ^this one^? ​

I may be misunderstanding. :seeya:​

​

​

 

[AnonymousD]

I wish I could see that whole report on the details. That is almost unbelievable.

eta: here's the full report

http://www.hods.org/pdf/Long Survival Following Baterial Meningits-Associated Brain Destruction1.pdf

Page 4 of this report, at the bottom, also references another child (who was also diagnosed with a form of meningitis) that is/was on a ventilator for 14 1/2 years after being declared brain dead.


So, my question for our K_Z is:
Is the brain decomposition shown in this report attributed more to the meningitis or the actual brain death (which was caused by the meningitis).

 

[PMLsmom]

I meant - It appears that they did extraordinary "life saving" type long term techniques, drugs, etc. He wasn't treated as Jahi was/is. He was given a LOT more...and it "sounds" like he was kept at a hospital (due to all of the procedures he was given), not a "long term care facility." Stuff like that...

 

[al66pine]

Wow! So it is possible for Jahi to be maintained on the ventilator for years! :banghead:

I wonder why this boy was maintained for so long on the ventilator once they knew he was braindead. Scary!

kaki,
From linked article, w my bolding:

"Despite EEG evidence of electrocerebral inactivity,
the family was opposed to his removal from life support."​

 

[CHERIE.T]

Yes, PML, where are our med professionals to advise on link?

"ABSTRACT
This report describes the brain autopsy of a boy who at age 4 1/2

​

​

years experienced an episode of fulminant Haemophilus influenzae type b bacterial meningitis, resulting in

massive brain destruction and the clinical signs of brain death.

However, medical intervention maintained him for an additional two decades....
This case represents an example of long survival of brain death with a living body. ​

(J Child Neurol 2006;21:591–595; DOI 10.2310/7010.2006.00137).

at page 2

"...he was ventilator dependent. Reflex responses of the limbs and trunk to tactile stimuli
consisting of nonpurposeful muscular movements were noted, along with ​

occasional apparently spontaneous limb movements...."

​

​

​

​

​

​

at page 2.

"...Median nerve somatosensory evoked potentials were recorded following stimulation of both the right and left sides,
with normal values for the median nerve conduction velocity

(right 68.3 milliseconds left 66.6 milliseconds, N13 latency (right 11.04 milliseconds; left 10.88 milliseconds),

and P14 latency (right 11.68 milliseconds; left 11.60 milliseconds);​

no N18 or N20 responses could be elicited...." BBM SBM
http://www.hods.org/pdf/Long%20Survival%20Following%20Baterial%20Meningits-Associated%20Brain%20Destruction1.pdf​

Does anyone read ^this^ as a finding inconsistent w brain death?

If so, then he had all clinical signs of brain death, but ^this one^? ​

I may be misunderstanding. :seeya:​

​

​

"This case represents an example of long survival of brain death with a living body."
(J Child Neurol 2006;21:591–595; DOI 10.2310/7010.2006.00137).

:banghead:

 

[CHERIE.T]

kaki,
From linked article, w my bolding:

"Despite EEG evidence of electrocerebral inactivity,
the family was opposed to his removal from life support."​

So brain dead...but kept on a ventilator for 20 odd years? sheeeessseee
How unbelievably selfish of his parents.

 

[al66pine]

I meant - It appears that they did extraordinary "life saving" type long term techniques, drugs, etc. He wasn't treated as Jahi was/is. He was given a LOT more...and it "sounds" like he was kept at a hospital (due to all of the procedures he was given), not a "long term care facility." Stuff like that...

Again from linked article, BBM SBM, re 20 yrs after Dx of bacterial meningitis:
"He required chronic care for most of his life. He was initially

transferred from a hospital setting to a chronic care facility that
specialized in ventilator patients. Eventually, arrangements were made
for his care in a small apartment in the basement of his mother’s home.
However, he later again required placement in a chronic care facility and
developed increasingly frequent respiratory infections, necessitating
more vigorous antibiotic therapy. In his final 2 months of life, he was
hospitalized twice with pneumonia and on the second hospitalization
developed transient diabetes insipidus, which had not been evident for
many years. On discharge from his last hospitalization, his mother
decided that no further resuscitative efforts should be undertaken, and he experienced a cardiac arrest in January 2004. Following his death, a​

brain-only autopsy was performed."

(Sorry for funny formatting of C & P from link. Can't seem to fix it.)

 

[PMLsmom]

Thanks al66 - I had a hard time with just the first 1-1/2 pages...Did not read it all.

 

[al66pine]

"This case represents an example of long survival of brain death with a living body."
(J Child Neurol 2006;21:591–595; DOI 10.2310/7010.2006.00137).

:banghead:

Yes, Cherie T.
I know the abstract said 'brain death,' but I still have Q about whether the other findings discussed in the body of the article
"normal values for the median nerve conduction velocity"
or
"occasional apparently spontaneous limb movements...."
could still occur in a person brain dead and brain-stem dead?

I understand foot movement reflex shown on mom's vid clip is not a sign of 'life' which is inconsistent w brain death,
because that reflex goes thru (is mediated by? term?) the spine, not brain.
So are the ^other findings^ explained the same way?
Again apologizing for my incredible med ignorance.

Anyone? :seeya:
Thx in adv.

 

[CHERIE.T]

Yes, Cherie T.
I know the abstract said 'brain death,' but I still have Q about whether the other findings discussed in the body of the article
"normal values for the median nerve conduction velocity"
or
"occasional apparently spontaneous limb movements...."
could still occur in a person brain dead and brain-stem dead?

I understand foot movement reflex shown on mom's vid clip is not a sign of 'life' which is inconsistent w brain death,
because that reflex goes thru (is mediated by? term?) the spine, not brain.
So are the ^other findings^ explained the same way?
Again apologizing for my incredible med ignorance.

Anyone? :seeya:
Thx in adv.

:seeya:
I also hope one of WS's medical people chime in about this.
I'm wondering if the movements mentioned in the medical report of the young man are associated with spinal cord reflexes.

 

[Donjeta]

Yes, PML, where are our med professionals to advise on link?

"ABSTRACT
This report describes the brain autopsy of a boy who at age 4 1/2

​

​

years experienced an episode of fulminant Haemophilus influenzae type b bacterial meningitis, resulting in

massive brain destruction and the clinical signs of brain death.

However, medical intervention maintained him for an additional two decades....
This case represents an example of long survival of brain death with a living body. ​

(J Child Neurol 2006;21:591–595; DOI 10.2310/7010.2006.00137).

at page 2

"...he was ventilator dependent. Reflex responses of the limbs and trunk to tactile stimuli
consisting of nonpurposeful muscular movements were noted, along with ​

occasional apparently spontaneous limb movements...."

​

​

​

​

​

​

at page 2.

"...Median nerve somatosensory evoked potentials were recorded following stimulation of both the right and left sides,
with normal values for the median nerve conduction velocity

(right 68.3 milliseconds left 66.6 milliseconds, N13 latency (right 11.04 milliseconds; left 10.88 milliseconds),

and P14 latency (right 11.68 milliseconds; left 11.60 milliseconds);​

no N18 or N20 responses could be elicited...." BBM SBM
http://www.hods.org/pdf/Long%20Survival%20Following%20Baterial%20Meningits-Associated%20Brain%20Destruction1.pdf​

Does anyone read ^this^ as a finding inconsistent w brain death?

If so, then he had all clinical signs of brain death, but ^this one^? ​

I may be misunderstanding. :seeya:​

​

​

The median nerve is in the arm. If you stimulate the nerves of a brain dead person in the limbs and elsewhere in the body, they can conduct impulses normally, only not to or from the brain.

The SEP components that they found are generated by the spinal cord or the nuclei in the junction of the spinal cord and the brainstem. The SEP components that they didn't find are generated in the brain.
See:

http://emedicine.medscape.com/article/1139906-overview#aw2aab6b6

 

[Donjeta]

:seeya:
I also hope one of WS's medical people chime in about this.
I'm wondering if the movements mentioned in the medical report of the young man are associated with spinal cord reflexes.

They must have been because there was nothing left in his brain that resembled brain structures. IMO.

 

[Donjeta]

Page 4 of this report, at the bottom, also references another child (who was also diagnosed with a form of meningitis) that is/was on a ventilator for 14 1/2 years after being declared brain dead.


So, my question for our K_Z is:
Is the brain decomposition shown in this report attributed more to the meningitis or the actual brain death (which was caused by the meningitis).

I'm not K_Z but the article states

..

of purulent bacterial meningitis, nuchal rigidity.
5–7
It is likely in
this case that the episode of meningitis produced the brain
destruction (resulting in the clinical signs indicating loss of brain
function) by the mechanism of either or both the increase in
intracranial pressure producing herniation
8
or the altered
cerebral blood flow from vasculitis.
9,10
Although the brain had
been destroyed during his acute illness, medical intervention
over the subsequent nearly two decades allowed the intracranial
changes to take place that were revealed at the time of autopsy.
Given that there was no brain to grow and enlarge the skull, the
head was microcephalic, and the calvarium was thickened.
Although, by definition, brain death entails no internal carotid or
vertebrobasilar artery blood flow, external carotid artery flow continued and permitted the dense calcification of the dura and replacement of adjacent brain parenchyma by ossification and focal areas of lose collagenous tissue. The finding that the interior of the specimen consisted mainly of mummified grumous material (with intermixed calcium deposits, clumped hemosiderin pigment, and focally mineralized cell processes)
and only a few foci of connective tissue indicates that blood flow
was insufficient over the two decades for macrophages to arrive
and remove most of the debris. This appearance of mummifica-
tion is very different from the pathologic changes reported
following meningitis in which death and autopsy occur a short
period after the onset of the bacterial meningitis.

In other words, his brain was destroyed by the meningitis but if he had been autopsied shortly afterwards it would have looked quite different so the decades of brain death caused the mummification.

Incidentally, when we discussed Shewmon's article (referenced here) in one of the earlier threads we speculated whether brain dead people could still grow. It appears that this young man hadn't grown since his brain death. He was microcephalic and 104 cm tall when he died which is about the size of a four year old (as he was when he got the meningitis), but weighed 70 kg which is an adult male weight. It must have been quite a sad sight for his poor family.

 

[ca2james]

In the article itself, it mentions the type of facility where she is located.

She has since been moved to a long-term care facility.

Interesting..... All other MSM have said that she was moved to an undisclosed location. I wonder if this station actually knows this or it's just speculation on their part. Once again I know that we'll probably never know the answer.

I also want to say that even though I personally am extremely curious about where she is, I would not actually want that information revealed - at least until this is all over and possibly never. The family deserve their privacy, as do the staff and other patients. A media circus and/or a group supporters gathering around would turn a sad situation into something ghastly for everyone concerned. No one deserves that.

 

[AnonymousD]

I'm not K_Z but the article states



In other words, his brain was destroyed by the meningitis but if he had been autopsied shortly afterwards it would have looked quite different so the decades of brain death caused the mummification.

Incidentally, when we discussed Shewmon's article (referenced here) in one of the earlier threads we speculated whether brain dead people could still grow. It appears that this young man hadn't grown since his brain death. He was microcephalic and 104 cm tall when he died which is about the size of a four year old (as he was when he got the meningitis), but weighed 70 kg which is an adult male weight. It must have been quite a sad sight for his poor family.

Thank you, donjeta.

Not only in this thread, but in countless others, I always find your posts thought provoking. I appreciate your input at WS!

 

[Trino]

This boy was brain dead for 20 years after a CNS infection, so Jahi won't be making any records for a while yet.

http://www.ncbi.nlm.nih.gov/pubmed/16970850

Good grief. Her family may not even be around to know what happens. How will they sue the hospital after so long?