Abstract
Background and purpose: Diagnosis of brain death requires confirmation of the clinical
diagnosis by appropriate tests, generally electroencephalography (EEG) and angiography.
The diagnostic limitations or logistical problems inherent to these tests indicate
the need to develop other more appropriate methods. The results obtained with transcranial
Doppler (TCD) led us to conduct this prospective study of TCD recordings in brain
dead patients. Methods: 130 patients, aged 2–88 years were diagnosed as brain dead
between July 1987 and June 1993. Clinical criteria were confirmed in all cases by
EEG (n=88) and or angiography (n=64). Intracranial anterior circulation was insonated via temporal windows or, when
impossible, via a transorbital approach. The posterior circulation was studied only
in more recent patients. Examinations were made as soon as possible after brain death
diagnosis and repeated for about 30 min. Vital parameters and treatments were taken
into account. Results: There was only one false negative result, in a patient with
an extended skull defect, who retained TCD and angiographic intracranial circulation
despite confirmed irreversible brain death. All other patients displayed typical ultrasonic
patterns of cerebral circulation arrest: an oscillating signal (n=190, 73%), a systolic spike (n=62, 24%) or a unilateral absence of signal (n=5). Despite a total correlation for positive diagnosis, TCD and angiography may differ
as to the level of circulation arrest. TCD is useful for patients under sedative drugs.
No false positive result was encountered but we were unable to insonate any intracranial
artery in 5 patients. Conclusion: Data from previous studies and the results of this
study indicate that TCD is a very sensitive and safe method for diagnosing cerebral
circulatory arrest. TCD may be used as a confirmatory test alongside EEG and angiography.
TCD is more widely applicable than EEG and may be earlier and safer than angiography.
Keywords
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References
President's Commission. Guidelines for the determination of brain death. J Am Med Assoc 1981;246:2184–7.
- Angiographic findings in brain death.Ann. New York Acad. Sci. 1978; 315: 168-183
- Digital substraction angiography (DSA) in the evaluation of brain death. A comparison of conventional cerebral angiography with intravenous and intra-arterial DSA.Neuroradiology. 1985; 27: 155-157
- Radionuclide cerebral imaging confirming brain death.J. Am. Med. Assoc. 1983; 249: 246-247
- Transcranial pulsed Doppler ultrasound findings in brainstem death.J. Neurol. Neurosurg. Psychiatry. 1987; 50: 1504-1513
- Transcranial Doppler study of intracranial circulatory arrest.J. Neurosurg. 1989; 71: 195-201
- Evaluation of brain death using transcranial Doppler.Neurosurgery. 1989; 24: 509-513
- Transcranial Doppler Ultrasound in brain death: experience in 140 patients.Neurol. Res. 1991; 13: 248-252
- Intérêt du Doppler transcrânien chez les patients suspects de mort cérébrale.Ann. Fr. Anesth. Réanim. 1992; 1: 415-423
- La mort cérébrale. Diagnostic et prise en charge en réanimation.Réan. Soins. Intens. Med. Urg. 1989; 5: 369-377
Société de Neurophysiologie Clinique de langue Franćaise. Recommandations quant aux conditions de réalisation d'un enregistrement électroancéphalographique exigibles pour le constat d'une mort cérébrale. Neurophysiol Clin 1989;19:339–41.
- Non invasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries.J. Neurosurg. 1982; 57: 769-774
- The role of transcranial Doppler in confirmating brain death: sensitivity, specificity, and suggestions for performance and interpretation.Neurology. 1990; 40: 300-303
- L'angiographie par voie veineuse: intérźt dans le diagnostic de la mort cérébrale. A propos de 125 observations.Bull. Acad. Nat. Med. 1995; 179: 27-40
- Intravenous digital substraction angiography. A criteria of brain death.Ann. Radiol. 1989; 32: 279-281
von Reutern GM. Zerebraler Zirkulationstillstand. Diagnostik mit der Dopplersonographie. Deutches Arzeblatt 88. Heft, 1991;49:1–5.
- Diagnosis of brain death by transcranial Doppler sonography.Arch. Dis. Child. 1988; 63: 1474-1478
- The critical first minutes after subarachnoid haemorrhage.Neurosurgery. 1988; 22: 654-661
- Transcranial Doppler evaluation of brain death.Neurosurgery. 1989; 25: 481-482
Article info
Publication history
Accepted:
May 4,
1998
Received in revised form:
April 29,
1998
Received:
October 16,
1997
Identification
Copyright
© 1998 Elsevier Science B.V. Published by Elsevier Inc. All rights reserved.
