Learning objectives
Explain the technique that consist in brain CT with and without intravenous contrast,
the indications and the radiologic sings to diagnosis brain death.
Background
Brain death marks an irreversible lack of brain functions.
In some dificult and complex cases of patients with metabolic disorders or patients treated with sedatives drugs,
in which the diagnosis of brain death after clinical examination,
additional testand EEG is subject to controversy, a brainCT with and withoutintravenous contrast can be helpful.
Our techniqueis based ontwo steps:
1- Brain CT scan without intravenous contrast.
2- CT angiography of the Willis Circle:
-We have toadministered 100 cc of intravenous contrast at a rate of 3 cc/s....
Imaging findings OR Procedure details
Normal findings in CT angiographyare:
- Permeablity of theinternal carotid artery and its branches.
- Permeablity of the external carotid artery and its branches.
-Presence of blood flow in the circle of Willis.
- Presence of blood flow in vertebrobasilar arteries.
In brain death our findings are in CT angiography:
-No bloodflow in intracranial circulation in the internal carotid artery and its branches.
-Persistent circulation in the branches of the external carotid artery.
- No flow in vertebro-basilar sistem
- No flow in oftalmic artery.
Conclusion
CT angiographyis a fast,
minimally invasive and easily accessible technique that can prove theabsence of intracranial flow after brain death.
This technique is useful for the confirmation of the diagnosis in complex cases of patients with metabolic disorders or sedated patients.
Findings consist of the absence of flowin theinternal carotid artery and its branches,and the persistence of flow in the external carotid artery.
Personal Information
B.
Prieto Hernández,
Departament of radiology; Hospital Clinico Universitario de Salamanca,
Salamanca; SPAIN
D.
Agueda del Bas,
Departament of radiology; Hospital Nuestra señora de Sonsoles,
Avila; SPAIN.
E.
Galvez Gonzalez;Departament of radiology; Hospital Clinico Universitario de Salamanca,
Salamanca; SPAIN
N.
Alegre Borge;Departament of radiology; Hospital Clinico Universitario de Salamanca,
Salamanca; SPAIN
N.
Menocal Funez;Departament of radiology; Hospital Clinico Universitario de Salamanca,
Salamanca; SPAIN
M.
Villanueva Delgado;Departament of radiology; Hospital Clinico Universitario de Salamanca,
Salamanca; SPAIN
References
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Grossman,
David M.
Yousem et al.
Neuroradiologia,
MARBAN 2001.
3- Dupas B,
Gayet-Delacroix M,
et al.
Angiographic and brain death diagnosis,
Elsevier 2003.
4- Dupas B,
Gayet – Delacroix M,
Villers D,
et al.
Diagnosis of brain death using two phase spiral TC.
AJNR Am J Neuroradiol 1998.
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The diagnosis of brain death.
N.Engl J Med 2001.
6- Bradac GB,
Simon RS,...
