ReviewNeurocritical care2021
Toxicologic Confounders of Brain Death Determination: A Narrative Review.
Review in Neurocritical care, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The Predictive Validity of the Full Outline of UnResponsiveness Score Compared to the Glasgow Coma Scale in the Intensive Care Unit: A Systematic Review.Neurocritical care · 2025Pooled it
- Early risk stratification for progression to death by neurological criteria following out-of-hospital cardiac arrest.Resuscitation · 2022Trial
- Management of Bupropion Toxicity With Intravenous Lipid Emulsion Therapy in a Pediatric Patient: A Case Report.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2026Article
- Pharmacologic and toxicologic confounders in brain death determination: a multidisciplinary guide.Critical care (London, England) · 2026Review
- Review
- ACMT Position Statement: Determining Brain Death in Adults and Children after Drug Overdose.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2026Article
- Dextromethorphan Overdose with Refractory Status Epilepticus and Reversible Cranial Nerve Reflex Loss: A Case Report.The American journal of case reports · 2025Article
- Role of Clinical and Multimodality Neuroimaging in the Evaluation of Brain Death/Death by Neurologic Criteria and Recent Highlights from 2023 Updated Guidelines.Diagnostics (Basel, Switzerland) · 2024Review
- Pharmacokinetic analysis of a phenobarbital overdose treated with urinary alkalinization alone.Toxicology reports · 2024Article
- Challenges to Brain Death in Revising the Uniform Determination of Death Act: The UDDA Revision Series.Neurology · 2023Article
- Potential pharmacological confounders in the setting of death determined by neurologic criteria: a narrative review.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2023Review
- Computed Tomography Angiography (CTA) in Selected Scenarios with Risk of Possible False-Positive or False-Negative Conclusions in Diagnosing Brain Death.Life (Basel, Switzerland) · 2022Review
- Intrathecal baclofen overdose mimicking brainstem death during deep brain stimulation surgery for pain.Annals of the Royal College of Surgeons of England · 2022Article
- Alprazolam and lorazepam overdose and the absence of brainstem reflexes.BMJ case reports · 2022Article
- Burst Suppression Electroencephalography (EEG) Pattern with Coma and Loss of Brain Stem Reflexes Following a Baclofen Overdose with Subsequent Full Recovery.The American journal of case reports · 2022Article
- Brain death: a clinical overview.Journal of intensive care · 2022Review
- Recent update on barbiturate in relation to brain disorder.EXCLI journal · 2021Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The aim of this narrative review is to describe the toxicologic confounders of brain death currently reported in the literature to offer guidance for physicians assessing brain death after a toxic exposure. We established an a priori definition of a "brain death mimic" as an unresponsive, intubated patient missing some, but not all brainstem reflexes. We completed a review of the literature utilizing MEDLINE and EMBASE to find case reports of patients of all ages in English, French, and Spanish meeting the criteria and hand searched the references of the results. We recorded xenobiotic dose, duration of physical exam suggesting brain death, and how the cases failed to meet full brain death criteria, when available. Fifty-six cases representing 19 different substances met the a priori definition of brain death mimic. Xenobiotic toxicities included: snake envenomation (13), baclofen (11), tricyclic antidepressants (8), bupropion (7), alcohols (4), antiepileptic agents (3), barbiturates (2), antidysrhythmics (2), organophosphates (2), and one case each of magnesium, succinylcholine, tetrodotoxin, and zolpidem. All patients except one survived to discharge and the majority at their baseline physical health. The most common means by which the cases failed brain death examination prerequisites was via normal neuroimaging. The xenobiotics in this review should be considered in cases of poisoning resulting in loss of brainstem reflexes and addressed before brain death determination. Brain death diagnosis should not be pursued in the setting of normal cerebral imaging or incomplete evaluation of brain death prerequisites.
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