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Abstract Details

Bobbing-Like Ocular Movements in a Patient with Brain Death
Neuro Trauma, Critical Care, and Sports Neurology
P5 - Poster Session 5 (5:30 PM-6:30 PM)
4-051
This case study aims to highlight the importance of a detailed neurological exam in brain death cases and the need for continued understanding of the work of the brainstem in brain death. 
A 52 year old woman was admitted to our institution after suffering a thunderclap headache followed by a cardiac arrest. Head CT showed a large right cerebellar hemorrhage with intraventricular extension, upward herniation of the superior vermis, and enlarged right temporal horn and MRI additionally revealed bilateral caudate and left putaminal acute infarcts, consistent with anoxic brain injury.
We describe a case report of a patient who presented to our University after having suffered cerebellar and intraventricular hemorrhage and who was found  to have bobbing-like eye movements at the time when her exam was otherwise consistent with brain death. 
On neurological examination, she was unresponsive to verbal or noxious stimuli, and she had no spontaneous movements; her pupils were dilated and unreactive; and she had no corneal, oculocephalic, oculovestibular, gag or cough reflexes.  However, she did have spontaneous eye movements: her eyes were deviated down, and had asynchronous slow small bobbing like movements with one eye moving down while the other going up and then repeats. An apnea test was performed and her exam was consistent with brain death per 好色先生 Brain Death guidelines, except for the bobbing-like eye movements. The patient was not declared brain dead.  The following day, the eye movements stopped and the diagnosis of brain death was made.
To our knowledge, this case report is the first of its kind, where a patient’s exam fulfilled brain death criteria, while still having subtle ocular movements. This highlights the importance of detailed and careful neurological exam and the continued need of further studying the brainstem in the setting of brain death. 
Authors/Disclosures
Julie McDaniel, MD (Carle Bromenn Medical Center)
PRESENTER 		Dr. McDaniel has nothing to disclose.
Enrique C. Leira, MD, MS, FAAN (University of Iowa Department of Neurology, Comprehensive Stroke Center) Dr. Leira has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. The institution of Dr. Leira has received research support from NIH-NINDS.
Deema A. Fattal, MD (Univ of Iowa) An immediate family member of Dr. Fattal has received research support from American transportation center and DOD.