Dilated Pupils and Brain Death
Authors: Thomas P. Bleck
Journal: Annals of Internal Medicine (1990)

Letters and Corrections15 April 1990Dilated Pupils and Brain DeathThomas P. Bleck, MDThomas P. Bleck, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-112-8-632_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editor: In their interesting and important study, Fraser and Arieff (1) thrice mention that the finding of fixed, dilated pupils suggested the diagnosis of brain death, and they further imply that the diagnosis of brain death may have been incorrect. These statements deserve comment.Fully dilated pupils are evidence of preserved sympathetic outflow and are incompatible with the diagnosis of brain death as it is commonly understood (2). The pupils of the brain-dead patient are midposition (4 to 6 mm in diameter) and fixed to light (3). Although the original statement of the "Harvard" criteria included the requirement...References1. FraserArieff CA. Fatal central diabetes mellitus and insipidus resulting from untreated hyponatremia: a new syndrome. Ann Intern Med. 1990;112:113-9. LinkGoogle Scholar2. . Defining Death: Medical, Legal, and Ethical Issues in the Determination of Death. Appendix F (Guidelines for the determination of death). Washington, D.C.: U.S. Government Printing Office; 1981. Google Scholar3. SmithBleck MT. Techniques for determining brain death. J Crit Illness. 1989;4:67-73. Google Scholar4. BeecherAdamsBarger HRA. A definition of irreversible coma. Report of the ad hoc committee of the Harvard Medical School to examine the definition of brain death. JAMA. 1968;205:337-40. CrossrefMedlineGoogle Scholar5. PlumPosner FJ. The Diagnosis of Stupor and Coma. Third edition. Philadelphia: F. A. Davis Co.; 1980:317. Google Scholar1. FraserArieff CA. Fatal central diabetes insipidus and mellitus resulting from untreated hyponatremia: a new syndrome. Ann Intern Med. 1990;112:113-9. LinkGoogle Scholar2. Arieff A. Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med. 1986;314:1529-35 CrossrefMedlineGoogle Scholar3. AyusKrathapalliArieff JRA. Treatment of symptomatic hyponatremia and relationship to brain damage: a prospective study. N Engl J Med. 1987;317:1190-5. CrossrefMedlineGoogle Scholar4. MurphyMurrayRobinsonCampion DABE. Outcomes of cardiopulmonary resuscitation in the elderly. Ann Intern Med. 1989;111:199-205. LinkGoogle Scholar5. BedellDelbancoCookEpstein STEF. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med. 1983;309:569-76. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Rush Medical College Chicago, IL 60612 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByInnsbruck coma scaleClinical Diagnosis of Brain Death 15 April 1990Volume 112, Issue 8Page: 632-633KeywordsBrain Issue Published: 15 April 1990 PDF DownloadLoading ...