Some of these potential health conditions that can arise during a neurologic examination include but are not limited to: sleep apnea (which causes gaps in breathing during sleep), seizures, and cardiac arrest. Because these conditions are so potentially dangerous, it is critical that they be properly diagnosed by a professional examiner. When a reviewer is sent to make a neurological diagnosis on a patient, it is crucial that the review focuses on the patient’s actual physical symptoms and the associated physiological mechanisms. This is where the term, ‘body image’ comes into play. Often, in these situations, a real physiologic abnormality can be misconstrued as a more benign health concern if it is seen by an examiner trained in diagnosing such abnormalities.
In order to correctly diagnose a brain death, an examiner must do more than simply look at the CPAP and EEG scans. In many instances, the only things needed are the clinical parameters listed in the patient’s medical history. In other cases, additional parameters will be required to make a conclusive diagnosis. If the clinical parameters are ambiguous, the reviewer must also look at the laboratory parameters in the assessment of brain death.
In the United States, all states require that anyone applying for admission to a hospital must be examined by a licensed physician. Additionally, all states require that this examination is done in a hospital licensed to perform this procedure. Therefore, in the United States, brain death is legally defined as occurring when the heart ceases to function or when the brain ceases to function. In some cases, other criteria may be used, including the reduction of all functioning limbs.
Because brain death can occur so quickly and unexpectedly, it is essential that all medical professionals involved in the assessment of brain death perform their duties reasonably well. Unfortunately, not all professionals are equally competent when it comes to making these judgments. This is because some medical professionals may be unfamiliar with the precise meaning of certain terms or they may be unfamiliar with the medical surveillance methods necessary to properly arrive at a conclusion regarding brain death. Such medical confounders can pose a threat to the accuracy of the final diagnosis, especially if the reviewer is not adequately familiar with the relevant literature.
For example, while the use of a ventilator may be the primary means of administering a treatment for a patient with an acute respiratory arrest (RSA), such a use might not necessarily be the most accurate determination of the diagnosis of a patient with normal hemoglobinopathies and normal oxygenation. Even if a ventilator is the primary method of treatment, it is likely that there will be many other criteria associated with a diagnosis of normal breathing that must be evaluated simultaneously with the use of a ventilator. When such criteria are not evaluated, the likelihood of misdiagnosis is greatly increased.
Such examples of misdiagnosed diagnoses can also occur with the clinical examination of a person who is suspected of having a stroke but does not have a history of stroke. It is possible for other factors, such as the presence of cough reflexes, tracheostomy abnormalities, or undetected brain disease, to result in the incorrect clinical diagnosis. Likewise, even if the clinical diagnosis is made on the basis of the presence of a cough reflex, the precise mechanism by which this reflex causes coughing is still unknown. If the examiner incorrectly diagnoses a patient with stroke instead of a disease based on the cough reflex, this may have serious consequences for the patient’s long term health and quality of life.
It is important that clinical studies that involve the use of a CT scan, MRI, or PET scanner accurately identify all of the patient’s functional imaging results, including those results derived from abnormal reflexes. However, it is also important that the examiner clearly defined what these abnormal reflexes are and how they affect the patient’s overall functioning. Patients with abnormal reflexes should never be given treatment or altered from their normal or normalizing cerebralstem with medications that do not directly address the underlying pathology of their condition.