Diagnóstico clínico de muerte encefálica y empleo del Doppler transcraneal, con ecografía de las arterias cerebrales medias y el segmento intracraneal de las arterias vertebrales. Concordancia con los hallazgos de la gammagrafía cerebral

Practice guidelines from the American Academy of Neurology for the determination of brain death in adults define brain death as “the irreversible loss of function of the brain, including the brainstem.” Neurological determination of brain death is primarily based on clinical examination; if clinical criteria are met, a definitive confirmatory test is indicated. The apnea test remains the gold standard for confirmation. In patients with factors that confound the clinical determination or when apnea tests cannot safely be performed, an ancillary test is required to confirm brain death. Confirmatory ancillary tests for brain death include (a) tests of electrical activity (electroencephalography (EEG) and somatosensory evoked potentials) and (b) radiologic examinations of blood flow (contrast angiography, transcranial Doppler ultrasound (TCD), and radionuclide methods). Of these, however, radionuclide studies are used most commonly. Here we present data from two patients with a false positive Radionuclide Cerebral Perfusion Scan (RCPS).

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Clinical Brain Death with False Positive Radionuclide Cerebral Perfusion Scans

Venkatram

Bughio

Diaz‐Fuentes

2015

Case Reports in Critical Care

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A Critique of Ancillary Tests for Brain Death

Young

Lee

2004

NCC

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The acceptance of brain death by society has allowed for the discontinuation of "life support" and the transplantation of organs. The standard clinical criteria for brain death, when rigorously applied, ensure that the brainstem is destroyed. Because more rostral structures are more vulnerable than the brainstem, these are almost invariably devastated when brainstem function is irreversibly lost as a result of whole brain insults. Then, clinical criteria for "brainstem death" ensure that "whole-brain death" is present. However, if the brainstem is selectively damaged or if brainstem function cannot be adequately assessed clinically, ancillary tests are needed to confirm whole-brain death with certainty. Ancillary tests are also required in very young children. In addition, some societies require their use as a matter of principle. Only tests of whole-brain perfusion adequately serve these purposes.

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Transcranial Sonography and Cerebral Circulatory Arrest in Adults: A Comprehensive Review

et al. 2013

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The diagnosis of brain death remains a clinical challenge for intensive care unit physicians. Worldwide regulations in its diagnosis may differ, and the need of ancillary tests after a clinical examination is not uniform. Transcranial sonography is a noninvasive, bedside, and widely available technique that can be used in the diagnosis of the cerebral circulatory arrest that preceeds brain death. In this paper we review the general concepts, the technical requisites, the patterns of Doppler signal confirming cerebral circulatory arrest, the vessels to insonate, and the options in cases with poor acoustic window. Future research perspectives in the field of transcranial sonography are discussed as well.

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Diagnóstico clínico de muerte encefálica y empleo del Doppler transcraneal, con ecografía de las arterias cerebrales medias y el segmento intracraneal de las arterias vertebrales. Concordancia con los hallazgos de la gammagrafía cerebral

Cited by 3 publications

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Clinical Brain Death with False Positive Radionuclide Cerebral Perfusion Scans

Clinical Brain Death with False Positive Radionuclide Cerebral Perfusion Scans

A Critique of Ancillary Tests for Brain Death

Transcranial Sonography and Cerebral Circulatory Arrest in Adults: A Comprehensive Review

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