Jahi McMath, un nuevo trastorno de la conciencia

Palabras clave: muerte encefálica, coma, síndrome de vigilia sin respuesta, síndrome de enclaustramiento, trastornos de la conciencia, exámenes complementarios, EEG, variabilidad del ritmo cardíaco, imágenes de resonancia magnética

Resumen

En este artículo, revisó el caso de Jahi McMath, quién fue diagnosticada con muerte encefálica (ME). No obstante, exámenes complementarios realizados nueve meses después de la lesión cerebral inicial mostraron conservación de las estructuras intracraneales, actividad en electroencefalografía EEG, y reactividad autonómica a estímulos llamados “Conversación de Madre”. Ella estaba clínicamente en un estado sin respuesta a los estímulos, sin evidencia de autoconciencia o conciencia del ambiente. Sin embargo, la ausencia total de reflejos del tronco encefálico y la capacidad de respuesta parcial rechazaron la posibilidad de un coma. Jahi no tenía síndrome de vigilia sin respuesta SVSR porque no estaba en un estado de vigilia y mostró una capacidad de respuesta parcial. Tampoco pudo ser clasificada como paciente LIS porque los pacientes LIS están despiertos y conscientes, y aunque tetrapléjicos, conservan total o parcialmente los reflejos del tronco encefálico, los movimientos oculares verticales u el parpadeo, y respiran por sí mismos. Ella no estaba en un EMC porque no preservaba la excitación y preservaba la conciencia solo parcialmente. La CRS-R dio una puntuación muy baja, incompatible con pacientes de EMC. Los pacientes de EMC preservan total o parcialmente los reflejos del tronco encefálico y, por lo general, respirar por sí solos. El EMC siempre se ha descrito como un estado de transición entre un coma y SVSR pero nunca se ha reportado en paciente con todos los hallazgos clínicos de ME. Este caso no contradice el concepto de ME pero vuelve a plantear la discusión acerca de la necesidad de utilizar exámenes complementarios en ME. Llegué a la conclusión de que Jahi representaba un nuevo trastorno de la conciencia, no descrito anteriormente, que he denominado "síndrome de no despertar con respuesta" (SNDR).

Biografía del autor/a

Calixto Machado, Institute of Neurology and Neurosurgery

Institute of Neurology and Neurosurgery, Havana, Cuba.

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Biografía del autor/a

Calixto Machado, Institute of Neurology and Neurosurgery

Institute of Neurology and Neurosurgery, Havana, Cuba.

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Cómo citar
Machado, C. (2021). Jahi McMath, un nuevo trastorno de la conciencia. Revista Latinoamericana De Bioética, 21(1), 137-154. https://doi.org/10.18359/rlbi.5635
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2021-07-23
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