Coma and brain stem areflexia in brain stem encephalitis (Fisher's syndrome).

Abstract

The assessment of brain stem function in comatose patients is now regular medical practice world wide. When envisaging a diagnosis of brain stem death it is essential, firstly, to establish that the patient is suffering from irremediable structural brain damage of known cause, and, secondly, to exclude the primary or contributory role of reversible causes of apnoeic coma with absent brain stem reflexes. Such causes include drug intoxication, hypothermia, and metabolic and endocrine disturbances.