Calixto MachadoInstitute of Neurology and Neurosurgery , Cuba
Title: Jahi Mcmath: The most controversial ever known case of suspected brain death
I was a main expert in 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 unarousable and unresponsive, 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 unresponsive wakefulness syndrome (UWS) because she was not in a wakefulness state and showed partial responsiveness. She could not be classified as a locked-in syndrome (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 respiring on their own. She was not in a minimally conscious state (MCS). The CRS-R resulted in a very low score, incompatible with MCS patients. MCS patients fully or partially preserve brainstem reflexes and usually breathe independently. MCS has always been described as a transitional state between a coma and UWS; MCS has never been reported in patients with all clinical BD findings. This case does not contradict the concept of BD but brings the need to use ancillary tests in BD again for discussion. I concluded that Jahi represented a new disorder of consciousness, non-previously described, which I have termed “responsive unawakefulness syndrome” (RUS).
Calixto Machado, MD, Ph.D., FAAN, is a Full Professor and Researcher in neurology and clinical neurophysiology and currently works at the Institute of Neurology and Neurosurgery, Havana, Cuba. In 1992, he was the first Cuban neurologist member of the American Academy of Neurology (AAN), nominated as a Corresponding Fellow. He is President of the Cuban Society of Clinical Neurophysiology and the President of the Organizing Committee of eight International Symposia on Brain Death and Disorders of Consciousness held in Havana since the early ’90s. Machado is recognized as a world expert in brain death, coma, disorders of consciousness, neuroimaging, clinical neurophysiology, stroke, and recently on the way, SARS-CoV-2 attacks the nervous system. He has been bestowed by many national and international Awards. In 2005 Dr. Machado received the AAN Lawrence McHenry Award. He was the main neurological expert in the Jahi McMath case, one of the most controversial suspected brain-dead patients, fully covered by the US and international press.