Brain Death Criteria
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þ Criteria per Schwartz, 3E, p 273
 - pupillary light reflex
 - corneal reflex
 - vestibulo-ocular (caloric) reflexes
 - gag reflex
 - cough reflex (to ET suction)
 - apnea despite pCO2 > 50

Urasaki E, Fukumura A, Itho Y, Itoyama Y, Yamada M, Ushio Y, Wada S, Yokota A
[Lazarus' sign and respiratory-like movement in a patient with brain death]
No To Shinkei 1988 Dec;40(12):1111-6

In the diagnosis of brain death, it is generally accepted that respiratory
function has to be absent, however, spinal reflexes can be preserved. We
presented a patient who showed a complex movements of upper limbs (Lazarus'
sign) and respiratory like movement during the apnea test for the
determination of brain death. This 72-year old female admitted to our
hospital in a semicomatous state due to severe subarachnoid and ventricular
hemorrhage. Her conscious level suddenly deteriorated to deep coma because
of second hemorrhage on the same day. She became apnea and no brain stem
reflexes elicited. Three days later, electrophysiological examination
revealed a flat recording of electroencephalography, absence of auditory
evoked potentials and no response of blink reflex. Short latency
somatosensory evoked potentials obtained by median nerve stimulation showed
the presence of Erb's N9 and spinal N13-P 13 components originating from
cervical dorsal horn, however, the scalp P13 generated by cervico-medullary
junction was absent. This patient fulfilled all other criteria for brain
death. Four days after, an apnea test was performed. Spontaneous movements
of both upper limbs were observed starting between 7 and 8 minutes after
disconnecting the intubation tube from the ventilator. Both arms flexed at
the elbow, abducted and elevated from the bed. Then, both hands were brought
up to chest. Wrist and fingers were in a neutral position (Lazarus' sign).
Simultaneously, shallow and irregular respiration like movements were
recognized. These movements ceased immediately after connecting the
respirator. These two types of movements were reproducible except for in the
final test. Blood pressure gradually decreased, and cardiac arrest occurred
one hour after.(ABSTRACT TRUNCATED AT 250 WORDS)

McNair NL, Meador KJ
The undulating toe flexion sign in brain death.
Mov Disord 1992 Oct;7(4):345-7

Brain-dead patients may exhibit gross spontaneous and reflex movements
(e.g., Babinski sign, stereotypic flexion of one or more limbs, and Lazarus
sign). We report three brain-dead patients who had unusual complex
sequential movements of the toes. Undulating toe flexion was elicited by
noxious stimuli to the lower extremities, and consisted of initial plantar
flexion of the great toe, followed by sequential brief plantar flexion of
the second, third, fourth, and fifth toes. The undulating toe flexion sign
differs from previously described responses characterized by plantar flexion
of the toes (e.g., Rosselimo's sign and the Mendel-Bechterew sign) in that
it consists of complex patterned sequential movements of the digits rather
than brief simultaneous flexion and/or fanning of the toes. Neurologists
should be aware of this unusual finding, which should not preclude the
diagnosis of brain death.