Learning objectives
The purpose of this presentation is to familiarize the reader with the magnetic resonance angiography imaging findings and diagnostic criteria of brain death in infants.
Background
The diagnosis and management of brain death is a frequently encountered clinical scenario,
particularly within the intensive care unit.
The diagnostic criteria of brain death have been included in guidelines,
both for adults and infants,
however testing for and determination of brain death is still subject of uncertainty and constant debate.(1,2)
Brain death corresponds to the irreversible cessation of all brain functions,
including the brainstem,
due to severe brain damage.(3) The process of diagnosing brain death involves neurologic testing,
consideration of confounders and,
if necessary,...
Findings and procedure details
MR angiographic examinations were performed on three clinically and EEG-proven brain-dead pediatric patients on a 1.5 Tesla Magnetom Avanto Siemens MR machine.
T1-TRIM,
T2-TSE,
FLAIR,
DWI (diffusion weighted imaging),
SWI (susceptibility weighted imaging),
3D arterial TOF,
Flash 3D ANGIO sequences where acquired for each individual in part before and after Gadolinium-based contrast administration.
Imaging findings included diffuse cerebral and cerebellar cytotoxic oedema with diffuse gyral swelling,
tonsillar herniation,
poor white-gray matter differentiation and arterial flow absence in the intracranial portion of the vertebral and internal...
Conclusion
The documentation of cerebral blood flow absence is conclusive evidence of brain death.
MRA imaging findings can be useful in confirming clinically and EEG- suspected brain death in the paediatric population,
potentially avoiding the toxic effects of CT contrast media on donor organs.
References
1.Wijdicks EFM,
Varelas PN,
Gronseth GS,
Greer DM,
American Academy of Neurology.
Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology.
Neurology.
2010 Jun 8;74(23):1911–8.
2.Nakagawa TA,
Ashwal S,
Mathur M,
Mysore M,
Society of Critical Care Medicine,
Section on Critical Care and Section on Neurology of American Academy of Pediatrics,
Child Neurology Society.
Clinical report—Guidelines for the determination of brain death in infants and children: an update of the 1987 task force recommendations....