Brazilian guidelines for the application of transcranial ultrasound as a diagnostic test for the confirmation of brain death

Abstract

Neurosonological studies, specifically transcranial Doppler (TCD) and transcranial color-coded duplex (TCCD), have high level of specificity and sensitivity and they are used as complementary tests for the diagnosis of brain death (BD). A group of experts, from the Neurosonology Department of the Brazilian Academy of Neurology, created a task force to determine the criteria for the following aspects of diagnosing BD in Brazil: the reliability of TCD methodology; the reliability of TCCD methodology; neurosonology training and skills; the diagnosis of encephalic circulatory arrest; and exam documentation for BD. The results of this meeting are presented in the current paper.Key words: transcranial Doppler, encephalic circulatory arrest, brain death. resumo Estudos neurossonológicos, especialmente o Doppler transcraniano (DTC) e o duplex transcraniano codificado a cores (DTCC), apresentam elevados níveis de especificidade e sensibilidade quando utilizados como exames complementares no diagnóstico de morte encefálica (ME). Um grupo de peritos do Departamento Científico de Doppler transcraniano da Academia Brasileira de Neurologia criou uma força-tarefa de forma a determinar os critérios neurossonológicos para os seguintes aspectos no diagnóstico de ME no Brasil: metodologia do DTC; metodologia do DTCC; treinamento e habilidades em Neurossonologia; diagnóstico de parada circulatória encefálica e documentação do exame para a ME. Os resultados deste encontro foram apresentados neste artigo.Palavras-Chave: Doppler transcraniano, parada circulatória encefálica, morte encefálica.

Latin American Consensus on the use of transcranial Doppler in the diagnosis of brain death

“…These features are considered confirmatory when they are described in the following three sectors: 1 and 2) left and right anterior sectors and 3) posterior sector (either basilar artery or both vertebral arteries). ( 5 , 30 , 31 )…”

How I manage sickle cell patients with high transcranial doppler results

“…In this study, the 98th centile measurement from a normally distributed curve was 128 cm/s and the authors recommended that velocities higher than that should be investigated further (Deane et al , ). National guidelines for stroke risk monitoring in the UK and USA do not recommend routine monitoring in HbSC disease, (Yawn & John‐Sowah, ) (UK Forum on Haemoglobin Disorders ), but the Brazilian National Guidelines do (Lange et al , ). The Brazilian guidelines recommend the use of the STOP study velocity criteria for stroke risk assessment in HbSC.…”

Aplicaciones de la ultrasonografía en el sistema nervioso central para neuroanestesia y cuidado neurocrítico

“…Las dos aplicaciones más aceptadas del doppler trascraneano son control de vasoespasmo en pacientes con hemorragia subaracnoidea (evidencia clase IIa) 16,38-47 y el apoyo del diagnóstico de muerte cerebral (evidencia IIa) [39][40][41][42][43][44][45][46][47][48] . Otras aplicaciones pero aún con evidencia limitada son el neuromonitoreo a través de velocidades de flujo en las principales arterias cerebrales, en el que se pretende monitorizar la hemodinámica cerebral [42][43][44][45] .…”