Korean J Neurotrauma.  2017 Oct;13(2):153-157. 10.13004/kjnt.2017.13.2.153.

Chronic Brain-Dead Patients Who Exhibit Lazarus Sign

• Moon JW
• Hyun DK

• KMID: 2394552
• DOI: http://doi.org/10.13004/kjnt.2017.13.2.153

Abstract

Lazarus sign, a complex reflex movement of the upper limbs after brain death, is a rare occurrence. We report two patients who showed a Lazarus sign following a diagnosis of brain death. It has been accepted that cardiac arrest usually occurs within 1 week after brain death; however, the two patients described herein survived for over 100 days after brain death was diagnosed. This report is intended to examine the relationship between the Lazarus sign and long-term survival after brain death, as well as to share our rare experience.

Keyword

Brain death; Brain stem; Lazarus sign; Reflex

MeSH Terms

Brain Death
Brain Stem
Diagnosis
Heart Arrest
Humans
Reflex
Upper Extremity

Figure

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  FIGURE 1 In the brain computed tomography performed on the day of admission, subarachnoid hemorrhage in both cerebral hemispheres and a large intracerebral hemorrhage in the left sylvian cistern area with intraventricular hemorrhage were found.

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  FIGURE 2 In the follow-up brain computed tomography performed on postoperative day 40, large cerebral herniation through the craniectomy site and decreased corticomedullary differentiation of the cerebral hemisphere were observed.

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  FIGURE 3 In the follow-up brain computed tomography performed on postoperative day 65, decreased cerebral herniation through the craniectomy site and no change of decreased corticomedullary differentiation of the cerebral hemisphere were observed.

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  FIGURE 4 In the follow-up brain computed tomography performed on postoperative day 142, resolving intraventricular hemorrhage in left frontal area and diffuse brain swelling with severe midline shift and increased pneumocephalus in left frontal lobe were observed.

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  FIGURE 5 No notable findings were observed in the brain computed tomography performed on the day of admission.

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  FIGURE 6 In the follow-up brain computed tomography performed on day 9 post-admission, diffuse severe brain swelling with transtentorial herniation was found.

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  FIGURE 7 The Lazarus sign. (A) Normal posture of the brain-dead patient; (B) posture when the Lazarus sign occurs: bilateral arm flexion to the chest, shoulder adduction, and hand crossing for about 10 to 30 seconds before returning to the normal posture.

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