Jahi McMath, a New Disorder of Consciousness

Jahi McMath, un nuevo trastorno de la conciencia;
Jahi McMath, um novo transtorno da consciência

dc.creatorMachado, Calixto
dc.date2021-07-23
dc.date2023-03-22T19:06:44Z
dc.date2023-03-22T19:06:44Z
dc.date.accessioned2023-09-06T18:05:02Z
dc.date.available2023-09-06T18:05:02Z
dc.identifierhttps://revistas.unimilitar.edu.co/index.php/rlbi/article/view/5635
dc.identifier10.18359/rlbi.5635
dc.identifierhttp://hdl.handle.net/10654/43459
dc.identifier.urihttps://repositorioslatinoamericanos.uchile.cl/handle/2250/8694114
dc.descriptionIn this paper, I review the case of Jahi McMath, who was diagnosed with brain death (BD). Nonetheless, ancillary tests performed nine months after the initial brain insult showed conservation of intracranial structures, EEG activity, and autonomic reactivity to the “Mother Talks” stimulus. She was clinically in an unarousable and unresponsive state, without evidence of self-awareness or awareness of the environment. However, the total absence of brainstem reflexes and partial responsiveness rejected the possibility of a coma. Jahi did not have uws because she was not in a wakefulness state and showed partial responsiveness. She could not be classified as a LIS patient either because LIS patients are wakeful and aware, and although quadriplegic, they fully or partially preserve brainstem reflexes, vertical eye movements or blinking, and respire on their own. She was not in an MCS because she did not preserve arousal and preserved awareness only partially. The CRS-R resulted in a very low score, incompatible with MCS patients. mcs patients fully or partially preserve brainstem reflexes and usually breathe on their own. MCS has always been described as a transitional state between a coma and UWS but never reported in a patient with all clinical BD findings. This case does not contradict the concept of BD but brings again the need to use ancillary tests in BD up for discussion. I concluded that Jahi represented a new disorder of consciousness, non-previously described, which I have termed “reponsive unawakefulness syndrome” (RUS).
dc.descriptionEn este artículo, revisó el caso de Jahi McMath, quién fue diagnosticada con muerte encefálica (ME). No obstante, exámenes complementarios realizados nueve meses después de la lesión cerebral inicial mostraron conservación de las estructuras intracraneales, actividad en electroencefalografía EEG, y reactividad autonómica a estímulos llamados “Conversación de Madre”. Ella estaba clínicamente en un estado sin respuesta a los estímulos, sin evidencia de autoconciencia o conciencia del ambiente. Sin embargo, la ausencia total de reflejos del tronco encefálico y la capacidad de respuesta parcial rechazaron la posibilidad de un coma. Jahi no tenía síndrome de vigilia sin respuesta SVSR porque no estaba en un estado de vigilia y mostró una capacidad de respuesta parcial. Tampoco pudo ser clasificada como paciente LIS porque los pacientes LIS están despiertos y conscientes, y aunque tetrapléjicos, conservan total o parcialmente los reflejos del tronco encefálico, los movimientos oculares verticales u el parpadeo, y respiran por sí mismos. Ella no estaba en un EMC porque no preservaba la excitación y preservaba la conciencia solo parcialmente. La CRS-R dio una puntuación muy baja, incompatible con pacientes de EMC. Los pacientes de EMC preservan total o parcialmente los reflejos del tronco encefálico y, por lo general, respirar por sí solos. El EMC siempre se ha descrito como un estado de transición entre un coma y SVSR pero nunca se ha reportado en paciente con todos los hallazgos clínicos de ME. Este caso no contradice el concepto de ME pero vuelve a plantear la discusión acerca de la necesidad de utilizar exámenes complementarios en ME. Llegué a la conclusión de que Jahi representaba un nuevo trastorno de la conciencia, no descrito anteriormente, que he denominado "síndrome de no despertar con respuesta" (SNDR).
dc.descriptionNeste artigo, foi revisado o caso Jahi McMath, que foi diagnosticada com morte encefálica (ME). Contudo, exames complementares realizados nove meses depois da lesão cerebral inicial mostraram conservação das estruturas intracranianas, atividade em eletroencefalografia (EEG) e reatividade autonômica a estímulos chamados “Conversación de Madre”. Ela estava clinicamente em um estado sem resposta aos estímulos, sem evidência de autoconsciência ou consciência do ambiente. Contudo, a ausência total de reflexos do tronco encefálico e a capacidade de resposta parcial rejeitaram a possibilidade de um coma. Jahi não tinha síndrome de vigia sem resposta (SVSR), porque não estava em um estado de vigia e mostrou uma capacidade de resposta parcial. Também não pode ser classificada como paciente LIS, porque estes estão acordados e conscientes, e ainda que tetraplégicos, conservam total ou parcialmente os reflexos do tronco encefálicos, os movimentos oculares verticais ou cintilação, e respiram por si próprios. Ela não estava em um EMC porque não preservava a excitação e preservava a consciência somente parcialmente. A CRS-R deu uma pontuação muito baixa, incompatível com pacientes de EMC. Os pacientes de EMC preservam total ou parcialmente os reflexos do tronco encefálico e, em geral, respirar por si só. O EMC sempre foi descrito como um estado de transição entre coma e SVSR, mas nunca foi relatado em paciente com todos os achados clínicos de ME. Esse caso não contradiz o conceito de ME, mas volta a colocar a discussão sobre a necessidade de utilizar exames complementares em ME. Cheguei à conclusão de que Jahi representava um novo transtorno da consciência, não descrito anteriormente, que denominei “síndrome de resposta sem vigília” (SRSV).
dc.formatapplication/pdf
dc.formattext/xml
dc.languageeng
dc.publisherUniversidad Militar Nueva Granada
dc.relationhttps://revistas.unimilitar.edu.co/index.php/rlbi/article/view/5635/4765
dc.relationhttps://revistas.unimilitar.edu.co/index.php/rlbi/article/view/5635/4821
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dc.rightsDerechos de autor 2021 Revista Latinoamericana de Bioética
dc.sourceRevista Latinoamericana de Bioética; Vol. 21 Núm. 1 (2021); 137-154
dc.source2462-859X
dc.source1657-4702
dc.subjectbrain death
dc.subjectcoma
dc.subjectunresponsive wakefulness syndrome
dc.subjectlocked-in syndrome
dc.subjectdisorders of consciousness
dc.subjectancillary tests
dc.subjectEEG
dc.subjectheart rate variability
dc.subjectmagnetic resonance imaging
dc.subjectmuerte encefálica
dc.subjectcoma
dc.subjectsíndrome de vigilia sin respuesta
dc.subjectsíndrome de enclaustramiento
dc.subjecttrastornos de la conciencia
dc.subjectexámenes complementarios
dc.subjectEEG
dc.subjectvariabilidad del ritmo cardíaco
dc.subjectimágenes de resonancia magnética
dc.subjectmorte encefálica
dc.subjectcoma
dc.subjectsíndrome de vigia sem resposta
dc.subjectsíndrome de encarceramento
dc.subjecttranstornos da consciência
dc.subjectexames complementares
dc.subjectEEG
dc.subjectvariabilidade do ritmo cardíaco
dc.subjectimagens de ressonância magnética
dc.titleJahi McMath, a New Disorder of Consciousness
dc.titleJahi McMath, un nuevo trastorno de la conciencia
dc.titleJahi McMath, um novo transtorno da consciência
dc.typeinfo:eu-repo/semantics/article
dc.typeinfo:eu-repo/semantics/publishedVersion


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