{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:29:37Z","timestamp":1761845377555},"reference-count":16,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T00:00:00Z","timestamp":1626912000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. J. Neurol. Sci."],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>ABSTRACT:<\/jats:title><jats:sec id=\"S0317167121001773_as1\"><jats:title>Background:<\/jats:title><jats:p>There is international variability in whether neurological determination of death (NDD) is conceptually defined based on permanent loss of brainstem function or \u201cwhole brain death.\u201d Canadian guidelines are not definitive. Patients with infratentorial stroke may meet clinical criteria for NDD despite persistent cerebral blood flow (CBF) and relative absence of supratentorial injury.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167121001773_as2\"><jats:title>Methods:<\/jats:title><jats:p>We performed a multicenter cohort study involving patients that died from ischemic or hemorrhagic stroke in Alberta intensive care units from 2013 to 2019, focusing on those with infratentorial involvement. Medical records were reviewed to determine the incidence and proportion of patients that met clinical criteria for NDD; whether ancillary testing was performed; and if so, whether this demonstrated the absence of CBF.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167121001773_as3\"><jats:title>Results:<\/jats:title><jats:p>There were 95 (27%) deaths from infratentorial and 263 (73%) from supratentorial stroke. Sixteen patients (17%) with infratentorial stroke had neurological examination consistent with NDD (0.55 cases per million per year). Among patients that underwent confirmatory evaluation for NDD with an apnea test, ancillary test (radionuclide scan), or both, ancillary testing was more common with infratentorial compared with supratentorial stroke (10\/12 (85%) vs. 25\/47 (53%), <jats:italic>p<\/jats:italic> = 0.04). Persistent CBF was detected in 6\/10 (60%) patients with infratentorial compared with 0\/25 with supratentorial stroke (<jats:italic>p<\/jats:italic> = 0.0001).<\/jats:p><\/jats:sec><jats:sec id=\"S0317167121001773_as4\"><jats:title>Conclusions:<\/jats:title><jats:p>Infratentorial stroke leading to clinical criteria for NDD occurs with an annual incidence of about 0.55 per million. There is variability in clinicians\u2019 use of ancillary testing. Persistent CBF was detected in more than half of patients that underwent radionuclide scans. Canadian consensus is needed to guide clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.1017\/cjn.2021.177","type":"journal-article","created":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T07:53:07Z","timestamp":1626940387000},"page":"553-559","source":"Crossref","is-referenced-by-count":8,"title":["Neurological Determination of Death Following Infratentorial Stroke: A Population-Based Cohort Study"],"prefix":"10.1017","volume":"49","author":[{"given":"Andreas H.","family":"Kramer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie A.","family":"Kromm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher J.","family":"Doig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Micha\u00ebl","family":"Chass\u00e9","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe L.","family":"Couillard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2021,7,22]]},"reference":[{"key":"S0317167121001773_ref5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.11586"},{"key":"S0317167121001773_ref13","doi-asserted-by":"publisher","DOI":"10.1097\/ANA.0000000000000568"},{"key":"S0317167121001773_ref7","doi-asserted-by":"publisher","DOI":"10.1053\/j.semnuclmed.2008.03.003"},{"key":"S0317167121001773_ref14","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awx176"},{"key":"S0317167121001773_ref3","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.58.1.20"},{"key":"S0317167121001773_ref6","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.045142"},{"key":"S0317167121001773_ref15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1812757"},{"key":"S0317167121001773_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31878-6"},{"key":"S0317167121001773_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2018.08.009"},{"key":"S0317167121001773_ref1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-019-03977-2"},{"key":"S0317167121001773_ref9","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s12028-017-0442-3","article-title":"Primary posterior fossa lesions and preserved supratentorial cerebral blood flow: implications for brain death determination","volume":"27","author":"Varelas","year":"2017","journal-title":"Neurocrit Care."},{"key":"S0317167121001773_ref4","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awr282"},{"key":"S0317167121001773_ref8","unstructured":"8. Chasse, M , Briard, JN , Yu, M , et\u00a0al. Clinical evaluation and ancillary testing for the diagnosis of death by neurological criteria: a cross-section survey of Canadian intensivists. Submitted for publication."},{"key":"S0317167121001773_ref11","first-page":"1","article-title":"How does the brain die after a massive posterior fossa lesion?","volume":"2","author":"Marcellino","year":"2020","journal-title":"Neurocrit Care."},{"key":"S0317167121001773_ref12","unstructured":"12. Canadian Council for Donation and Transplantation. Legal foundations for the neurological determination of death. Available at: https:\/\/professionaleducation.blood.ca\/sites\/msi\/files\/Legal-Neurological-Death.pdf"},{"key":"S0317167121001773_ref10","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-019-09338-5"}],"container-title":["Canadian Journal of Neurological Sciences \/ Journal Canadien des Sciences Neurologiques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0317167121001773","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,30]],"date-time":"2022-06-30T01:09:28Z","timestamp":1656551368000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0317167121001773\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,22]]},"references-count":16,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,7]]}},"alternative-id":["S0317167121001773"],"URL":"https:\/\/doi.org\/10.1017\/cjn.2021.177","relation":{},"ISSN":["0317-1671","2057-0155"],"issn-type":[{"value":"0317-1671","type":"print"},{"value":"2057-0155","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,22]]}}}