Elsevier

Transplantation Proceedings

Volume 35, Issue 5, August 2003, Pages 1642-1643
Transplantation Proceedings

Organ donation and procurement
Persistence of intracranial diastolic flow in transcranial Doppler sonography exploration of patients in brain death

https://doi.org/10.1016/S0041-1345(03)00692-4Get rights and content

Abstract

Objective

The persistence of cerebral blood flow (CBF) in patients with whole brain death (BD) diagnosis is an unusual phenomenon. We describe patients with whole BD diagnosed despite persistence of intracranial blood flow on transcranial Doppler sonography (TDS).

Materials and methods

From January 2001 to December 2002, we reviewed the records of 11 patients. Etiology of BD was craniocephalic trauma in 2 cases, schemic cerebrovascular accident (CVA) in 4 cases, Hemorrhagic CVA in 3 cases, subaracnoid hemorrhage in 1 case, and acute hydrocephalus in 1 case. Six patients had a cerebral decompressive mechanism. In all patients, TDS was used to confirm BD after clinical diagnosis. Additionally, all patients underwent an electroencephalogram (EEG). In 3 patients cerebral angiography (CA) and in 2 others radionuclide angiography (RA) with Tc99m HMPAO were done.

Results

All TDS studies showed persistent telediastolic positive flow in at least 1 artery. Because the TDS did not confirm the clinical diagnosis of BD, EEG tests were performed showing silence of bioelectrical activity. Those cases showed CA or RA results with a complete absence of CBF.

Conclusion

The TDS technique directly evaluates the intracranial but not the intracerebral circulation. For this reason, during the BD diagnosis for patients with previous decompressive techniques, it was possible to find persistance of intracranial telediastolic flow using TDS. In those cases, it is advisable to use other tests to confirm the clinical diagnosis of BD.

Section snippets

Materials and methods

Between January 2001 and December 2002, we reviewed the records of 11 patients with the clinical diagnosis of whole BD but with persistence of intracranial blood flow demonstrated on TDS. There were 9 men and 2 women at mean age of 46.6 years (range, 29–68 years). Six patients were treated and evaluated in the Intensive Care Unit (ICU) of the Hospital Clinic at Barcelona and 5 in the ICU of the Hospital Virgen del Rocio at Seville, Spain. The etiology of BD was craneoencephalic trauma (CET) in

Results

During the ICU stay all patients were treated and followed up by the intensivist in charge of the unit. To assess the evolution of neurological damage, all patients were continuously monitored with TDS to control CBF. After the clinical diagnosis of whole BD, TDS exploration was performed to evaluate 4 cerebral arteries (bilateral middle cerebral and vertebral arteries). All studies showed persistent telediastolic positive flow in at least 1 artery; the arterial registries showed an elevated

Discussion

Although clinical exploration is essential for the diagnosis of BD, when the concept of whole BD is used it is useful and advisable to perform an instrumental test to explore all supratentorial structures.2, 4 Commonly, CBF exploratory tests are suggested when the patient has been under treatment with CNS sedative drugs or presents metabolic disorders. Also, it is convenient to perform these tests to reduce the observation period between clinical exploration and to show the relatives to

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