Biography
Calixto Machado has completed MD and PhD from the Unviersity of Havana, Cuba. He is a Senior Professor and Researcher at the Institute of Neurology and Neurosurgery. He is a Corresponding Felow of the American Academy of Neurology (AAN), and President of the Cuban Society of Clinical Neurophysiology. In 2005 he received the AAN “Lawrence McHenry Awardâ€. He has published more than 400 peer reviewed articles. His Book “Brain Death: A Reappraisal†was received with great enthusiasm among scholars. He is considered one of the most productive investigators in the area of brain death and disorders of consciousness.
Abstract
Jahi McMath was declared braindead, but ancillary tests performed 9 months after initial brain insult, showed conservation of intracranial structures, EEG activity, and autonomic reactivity to “Mother Talks†stimulus. I concluded that she was not braindead, but in a state of disorder of consciousness not previously described. She was clinically unarousable, without evidence of awareness of self or environment, but full absence of brainstem reflexes, and partial responsiveness, rejected the possibility of being in coma. Jahi was not an unresponsive wakefulness syndrome (UWS), because she showed partial responsiveness, and UWS cases fully or partially preserve brainstem reflexes. Locked-in (LIS) patients are wakeful and aware, and although these cases are quadriplegic, they preserve brainstem reflexes, vertical eye movements, and/or blinking, and respire by their own, rejecting the possibility of classifying her as a LIS. She was not a minimally conscious state (MCS) because she did not preserve arousal, and partially preserved awareness. The CRS-R in Jahi McMath would had resulted in a very low score, not corresponding with MCS patients. MCS patients fully or partially preserve brainstem reflexes, and usually breathe by their own. MCS has been described as a transitional state between coma, UWS. MCS has never been reported in a patient fullfiling all clinical brain death (BD) findings. This case doesn’t contradict the concept of BD, but brings again to discussion the needs of using ancillary tests in BD. Jahi McMath represented a new state of disorder of consciousness, non-previously described, that I have termed: “responsive unawake syndrome†(RUS).
