Learning objectives
Identify and know the most important radiological findings for the diagnosis of brain death.
Review the essential role of CT angiography in the diagnosis of brain death.
Background
Brain death (BD) is the irreversible cessation of the functions of intracranial neurological structures,
including the cerebral hemispheres and brainstem.
It appears when the intracranial pressure is higher than the systolic arterial pressure,
which leads to cerebral circulatory arrest.
The declaration of BD has great medical,
ethical and legal transcendence,
because it makes it possible to remove all artificial life-support measures from the patient,
or to extract organs for transplantation.
The diagnosis must be carried out by doctors with experience in the management of neurocritical...
Findings and procedure details
Preconditions:
- Thermodynamically stable patient: Mean arterial pressure >65 mmHg,
diuresis >100 ml/h,
CVP 6-8 mmHg (to prevent renal damage secondary to iodinated contrast).
- It is recommended to wait for at least 6 hours between the clinical diagnosis of BD and the angio-CT scan,
because the pressure of the brain perfusion during the first hours after diagnosis may be enough to maintain cerebral flow.
Scanning protocol:
An MDCT scanner is preferred because it has higher resolution,
good quality in its reconstructions and a decrease...
Conclusion
Angio-CT is a fast,
minimally invasive and readily available test.
Consequently,
its use has increased in the diagnosis of instrumental BD.
Also,
it requires standardization of the protocols of acquisition and interpretation.
Knowing the imaging findings of brain death makes it possible to remove the artificial life support instruments,
to avoid prolonged maintenance and to carry out an adequate extraction of the organs.
A full-body CT scan may show relevant information (e.g.: possible tumor lesions,
measure of organs) to classify the patient as a potential...
References
Escudero D.,
Otero J.,
Marqueet L.
et al.
Diagnosing Brain Death by CT Perfusion and Multislice CT Angiography.
Neurocrit Care 2009;11:261-271.
Wijdicks EF.
The case against confirmatory tests for determing brain deaths in adults.
Neurology 2010;75:77-83.
Wijdicks E.,
Varelas P.,
Gronseth G.,
et al.
Evidence-based guideline update: Determining brain death in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology.
Neurology 2010;74:1911.
Greer D.,
Strozyk D.,
Schwamm L.
False positive CT Angiography in Brain Death.
Neurocrit Care;11:272-275.
Van der Lugt #....