A 70-year-old man on ICU has a GCS of 3 following a massive pontine haemorrhage. He has absent brainstem reflexes and no respiratory drive. The neurol...

Question

A 70-year-old man on ICU has a GCS of 3 following a massive pontine haemorrhage. He has absent brainstem reflexes and no respiratory drive. The neurology team confirms there is no prospect of recovery. The family is informed and agrees to withdrawal of treatment. During the withdrawal process, the patient develops spinal reflexes (triple flexion response in the lower limbs). The family is distressed, believing the patient is experiencing pain. What should the team communicate?

Accepted Answer

Spinal reflexes (including triple flexion, Lazarus sign) can persist after brainstem death or during the dying process - they are mediated by spinal cord circuits and do NOT indicate consciousness, pain, or suffering; the family should be reassured and prepared for this possibility

Answer

The patient is in pain and requires more analgesia

Answer

The patient is recovering consciousness

Answer

The withdrawal process must be stopped

Answer

These movements indicate the patient needs neuromuscular blockade

uk-fficm MCQ (SBA): Spinal Reflexes During Withdrawal