Difficulties in assessing brain death in a case of benzodiazepine poisoning with persistent cerebral blood flow

2004 ◽  
Vol 23 (10) ◽  
pp. 503-505 ◽  
Author(s):  
Frédéric Marrache ◽  
Bruno Megarbane ◽  
Stéphane Pirnay ◽  
Abdel Rhaoui ◽  
Marie Thuong
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Cerebral Blood Flow ◽  
Brain Death ◽  
Intracranial Hypertension ◽  
Multiorgan Failure ◽  
Deep Coma ◽  
Ventricular Drainage ◽  
Eeg Activity ◽  
Anoxic Injury

Assessing brain death may sometimes be difficult, with isoelectric EEG following psychotrope overdoses or normal cerebral blood flow (CBF) persisting despite brain death in the case of ventricular drainage or craniotomy. A 42-year-old man, resuscitated after cardiac arrest following a suicidal ingestion of ethanol, bromazepam and zopiclone, was admitted in deep coma. On day 4, his brainstem reflexes and EEG activity disappeared. On day 5, his serum bromazepam concentration was 817 ng/ml (therapeutic: 80-150). The patient was unresponsive to 1 mg of flumazenil. MRI showed diffuse cerebral swelling. CBF assessed by angiography and Doppler remained normal and EEG isoelectric until he died on day 8 with multiorgan failure. There was a discrepancy between the clinically and EEG-assessed brain death, and CBF persistence. We hypothesized that brain death, resulting from diffuse anoxic injury, may lead, in the absence of major intracranial hypertension, to angiographic misdiagnoses. Therefore, EEG remains useful to assess diagnosis in such unusual cases.

scholarly journals Bedside contrast-enhanced ultrasound diagnosing cessation of cerebral circulation in a neonate: A novel bedside diagnostic tool

2018 ◽  
Vol 31 (6) ◽  
pp. 578-580 ◽  
Author(s):  
Misun Hwang ◽  
Becky J Riggs ◽  
Sandra Saade-Lemus ◽  
Thierry AGM Huisman
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Cerebral Blood Flow ◽  
Case Report ◽  
Brain Death ◽  
Unknown Etiology ◽  
Clinical Implications ◽  
Contrast Enhanced Ultrasound ◽  
Imaging Diagnosis ◽  
Contrast Enhanced

Imaging diagnosis of brain death is performed with either four-vessel cerebral angiography or radionuclide cerebral blood flow studies. Unfortunately, timely performance of either study at a critically ill period is not only cumbersome but not feasible in many cases. We present a case of a 6-month-old male three hours status post-cardiac arrest of unknown etiology who underwent contrast-enhanced ultrasound (CEUS) for diagnosis of near absent perfusion, or near brain death. The patient passed away 30 minutes after the exam and clinical diagnosis of brain death was confirmed. The case report highlights the utility of CEUS for diagnosis of brain death. This can have significant clinical implications in neonates who may not be eligible for commonly used, cumbersome radiologic studies for diagnosis of brain death.

REGIONAL CEREBRAL BLOOD FLOW, EVOKED POTENTIAL RESPONSES, AND PERIPHERAL HEMODYNAMICS DURING INTRACRANIAL HYPERTENSION

1985 ◽  
Vol 13 (4) ◽  
pp. 286
Author(s):  
Joanne E. Backofen ◽  
Raymond C. Koehler ◽  
Robert W. McPherson ◽  
Mark C. Rogers ◽  
Richard J. Traystman
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Intracranial Hypertension ◽  
Regional Cerebral Blood Flow ◽  
Evoked Potential ◽  
Regional Cerebral Blood ◽  
Peripheral Hemodynamics

Dynamic Computed Tomography Angiography in Suspected Brain Death: A Noninvasive Biomarker

2014 ◽  
Vol 65 (4) ◽  
pp. 352-359 ◽  
Author(s):  
Santanu Chakraborty ◽  
Reem A. Adas
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Brain Death ◽  
Internal Carotid ◽  
External Carotid Artery ◽  
External Carotid ◽  
Ancillary Test ◽  
Organ Harvesting

Purpose Neurologic determination of death or brain death is primarily a clinical diagnosis. This must respect all guarantees required by law and should be determined early to avoid unnecessary treatment and allow organ harvesting for transplantation. Ancillary testing is used in situations in which clinical assessment is impossible or confounded by other factors. Our purpose is to determine the utility of dynamic computed tomographic angiography (dCTA) as an ancillary test for diagnosis of brain death. Materials and Methods We retrospectively reviewed 13 consecutive patients with suspected brain death in the intensive care unit who had dCTA. Contrast appearance timings recorded from the dCTA data were compared to findings from 15 controls selected from patients who presented with symptoms of acute stroke but showed no stroke in follow-up imaging. Results The dCTA allows us to reliably assess cerebral blood flow and to record time of individual cerebral vessels opacification. It also helps us to assess the intracranial flow qualitatively against the flow in extracranial vessels as a reference. We compared the time difference between enhancement of the external and internal carotid arteries and branches. In all patients who were brain dead, internal carotid artery enhancement was delayed, which occurred after external carotid artery branches were opacified. Conclusion In patients with suspected brain death, dCTA reliably demonstrated the lack of cerebral blood flow, with extracranial circulation as an internal reference. Our initial results suggest that inversion of time of contrast appearance between internal carotid artery and external carotid artery branches at the skull base could predict a lack of distal intracranial flow.

Persistence of Cerebral Blood Flow After Brain Death

2000 ◽  
Vol 93 (4) ◽  
pp. 364-370 ◽  
Author(s):  
W MEL. FLOWERS ◽  
BHARTI R. PATEL
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Brain Death

Brain Death in the Newborn

PEDIATRICS ◽  
1989 ◽  
Vol 84 (3) ◽  
pp. 429-437
Author(s):  
Stephen Ashwal ◽  
Sanford Schneider
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Brain Death ◽  
Clinical Findings ◽  
Term Infants ◽  
Clinical Criteria ◽  
Brain Dead ◽  
Electroencephalographic Activity ◽  
Radionuclide Uptake

The clinical courses of 18 preterm and term infants less than 1 month of age in whom brain death was diagnosed were retrospectively reviewed. Clinical diagnosis was determined neurologically and included (1) coma, (2) apnea, manifested by inability to sustain respiration, and (3) absent brainstem reflexes. Electroencephalograms were performed in all patients; 17 patients had adequate cerebral blood flow as estimated by radionuclide imaging. The results indicate that (1) neurodiagnostic tests such as electroencephalograms and radionuclide scanning reconfirmed clinically determined brain death in only one half to two thirds of patients; (2) electrocerebral silence in the absence of barbiturates, hypothermia, or cerebral malformations during 24 hours was confirmatory of brain death if the clinical findings remained unchanged; (3) absence of radionuclide uptake associated with initial electrocerebral silence was associated with brain death; (4) term infants clinically brain dead for 2 days and preterm infants brain dead for 3 days did not survive despite electroencephalogram or cerebral blood flow status; and (5) phenobarbital levels > 25 µg/ mL may suppress electroencephalographic activity in this age group. The findings suggest that determination of brain death in the newborn can be made solely by using clinical criteria. Confirmatory neurodiagnostic studies are of value because they can potentially shorten the period of observation.

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