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Intellectual Death Is Not Brain Death

With respect to the letter by Wijdicks, I suggest that it is extremely unlikely that physicians would actually confuse the legal concept of brain death in the context of a comatose state with that of intellectual deterioration associated with multiinfarct dementia. The purpose of my editorial (1) was to draw attention to the fact that "silent" infarcts associated with apnea might not only be relevant to vascular disease per se but also to cognitive impairment. The choice of the title "Brain Death by a Thousand Hypoxic Cuts in Sleep" was meant to evoke the well-known phrase "death by a thousand cuts," and clearly was not intended to suggest the state of brain death associated with comatose states. By scientific medical definition, a stroke results in brain tissue that has undergone death.

I wrote the editorial to draw attention to an article (2) that merits clinical and educational attention, and to help stimulate interest in research on the topics of sleep apnea, stroke, and cognitive impairment. This is certainly a worthwhile endeavor for an academic journal.

Brian J. Murray

Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada

FOOTNOTES

Conflict of Interest Statement: The author has no financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Murray BJ. Brain death by a thousand hypoxic cuts in sleep [editorial]. Am J Respir Crit Care Med 2007;175:528–529.[Free Full Text]
2. Minoguchi K, Yokoe T, Tazaki T, Minoguchi H, Oda N, Tanaka A, Yamamoto M, Ohta S, O'Donnell CP, Adachi M. Silent brain infarction and platelet activation in obstructive sleep apnea. Am J Respir Crit Care Med 2007;175:612–617.[Abstract/Free Full Text]

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