A case of a child who developed Cushing reflex after a clinical diagnosis of brain death

The author presents a case of brain death caused by salmonella encephalopathy in a 1-year-old girl. The patient suffered from fever, convulsive status, and coma. On the 5th day, her respiration was arrested. At that time, we confirmed the absence of brainstem reflexes. An electroencephalogram (EEG) showed a flat pattern. Only wave I was recordable in auditory brainstem responses (ABR). On the 6th day, we obtained a flat EEG and a disappearance of all components of ABR. A simultaneous elevation of her heart rate and blood pressure was observed 14 to 18 hours after the respiratory arrest. This phenomenon was equivalent to the Cushing reflex, which represents an autoregulation against increased intracranial pressure. Our case suggested that the activity of a part of the brainstem was preserved in spite of the absence of activities in EEG, ABR and brainstem reflexes at 14 hours after the onset of apnea.