scholarly journals Assessment of Cerebral Circulatory Arrest via CT Angiography and CT Perfusion in Brain Death Confirmation

2020 ◽  
Vol 21 ◽  
Author(s):  
Asli Irmak Akdogan ◽  
Yeliz Pekcevik ◽  
Hilal Sahin ◽  
Ridvan Pekcevik
Keyword(s):  
Brain Death ◽  
Ct Angiography ◽  
Ct Perfusion ◽  
Circulatory Arrest ◽  
Cerebral Circulatory Arrest

Transcranial Doppler Ultrasonography in the Determination of Brain Death

Neurosurgery ◽  
1989 ◽  
Vol 24 (6) ◽  
pp. 884-889 ◽  
Author(s):  
Alexandros D. Powers ◽  
Michael C. Graeber ◽  
Robert R. Smith
Keyword(s):  
Brain Death ◽  
Flow Velocity ◽  
Pulse Pressure ◽  
Transcranial Doppler ◽  
Circulatory Arrest ◽  
Neurological Function ◽  
Wave Form ◽  
Retrograde Flow ◽  
Cerebral Circulatory Arrest ◽  
Flow Velocities

Abstract Transcranial Doppler (TCD) ultrasonography was used to perform multiple examinations of 24 patients who sustained cranial injuries, 23 of whom progressed to death. In the 20 of these 23 patients for whom an adequate TCD signal could be obtained, a characteristic reverberating wave form pattern was observed, with an associated net flow velocity of <10 cm/sec in all cases. In the last patient in our study group, a reverberating pattern was also identified, however, a net flow velocity of >20 cm/sec was associated with functional recovery. Correlations of neurological function, TCD tracings, and net flow velocities permitted identification of characteristic hemodynamic changes that preceded cerebral circulatory arrest. Early changes included decreased flow velocity as well as an increase in pulse pressure. Late changes consisted of a persistent increase of pulse pressure with the appearance of retrograde flow velocities during diastole. In the end stage, complete diastolic retrograde flow velocities were found. These gave rise to the characteristic reverberating pattern mentioned earlier. Identification of flow velocity reversal alone, however, proved to be inadequate for making the diagnosis of brain death. Evaluation of net flow velocity (calculated at bedside) was found to be a more sensitive determinant of brain death and closely paralleled the patients' neurological function.

Diagnosing Brain Death by CT Perfusion and Multislice CT Angiography

2009 ◽  
Vol 11 (2) ◽  
pp. 261-271 ◽  
Author(s):  
Dolores Escudero ◽  
Jesús Otero ◽  
Lara Marqués ◽  
Diego Parra ◽  
José Antonio Gonzalo ◽  
...  
Keyword(s):  
Brain Death ◽  
Ct Angiography ◽  
Ct Perfusion ◽  
Multislice Ct

Computed tomography angiography accuracy in brain death diagnosis

2020 ◽  
Vol 133 (4) ◽  
pp. 1220-1228
Author(s):  
Sergio Brasil ◽  
Edson Bor-Seng-Shu ◽  
Marcelo de-Lima-Oliveira ◽  
Fabio Silvio Taccone ◽  
Gabriel Gattás ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Brain Death ◽  
Computed Tomography Angiography ◽  
Circulatory Arrest ◽  
Cerebral Veins ◽  
Clinical Trial Registration ◽  
Bilateral Absence ◽  
Internal Cerebral Veins ◽  
Cerebral Circulatory Arrest

OBJECTIVEThe present study was designed to answer several concerns disclosed by systematic reviews indicating no evidence to support the use of computed tomography angiography (CTA) in the diagnosis of brain death (BD). Therefore, the aim of this study was to assess the effectiveness of CTA for the diagnosis of BD and to define the optimal tomographic criteria of intracranial circulatory arrest.METHODSA unicenter, prospective, observational case-control study was undertaken. Comatose patients (Glasgow Coma Scale score ≤ 5), even those presenting with the first signs of BD, were included. CTA scanning of arterial and venous vasculature and transcranial Doppler (TCD) were performed. A neurological determination of BD and consequently determination of case (BD group) or control (no-BD group) was conducted. All personnel involved with assessing patients were blinded to further tests results. Accuracy of BD diagnosis determined by using CTA was calculated based on the criteria of bilateral absence of visualization of the internal cerebral veins and the distal middle cerebral arteries, the 4-point score (4PS), and an exclusive criterion of absence of deep brain venous drainage as indicated by the absence of deep venous opacification on CTA, the venous score (VS), which considers only the internal cerebral veins bilaterally.RESULTSA total of 106 patients were enrolled in this study; 52 patients did not have BD, and none of these patients had circulatory arrest observed by CTA or TCD (100% specificity). Of the 54 patients with a clinical diagnosis of BD, 33 met the 4PS (61.1% sensitivity), whereas 47 met the VS (87% sensitivity). The accuracy of CTA was time related, with greater accuracy when scanning was performed less than 12 hours prior to the neurological assessment, reaching 95.5% sensitivity with the VS.CONCLUSIONSCTA can reliably support a diagnosis of BD. The criterion of the absence of deep venous opacification, which can be assessed by use of the VS criteria investigated in this study, can confirm the occurrence of cerebral circulatory arrest.Clinical trial registration no.: 12500913400000068 (clinicaltrials.gov)

scholarly journals Selective 4 Vessels Angiography in Brain Death: A Retrospective Study

2010 ◽  
Vol 37 (4) ◽  
pp. 492-497 ◽  
Author(s):  
Martin Savard ◽  
Alexis F. Turgeon ◽  
Jean-Luc Gariépy ◽  
François Trottier ◽  
Stephan Langevin
Keyword(s):  
Retrospective Study ◽  
Brain Death ◽  
Circulatory Arrest ◽  
Venous Drainage ◽  
Arterial Blood Flow ◽  
Clinical Practices ◽  
Brain Death Diagnosis ◽  
Arterial Blood ◽  
Cerebral Circulatory Arrest ◽  
Study Population

Background:In Canada, ancillary tests, such as selective four vessels angiography (S4VA), are sometimes necessary for brain death (BD) diagnosis when the clinical exam cannot be completed or confounding factors are present. Recent Canadian guidelines assert that brain death is supported by the absence of arterial blood flow at the surface of the brain and that venous return should not be considered. However, neuropathologic and angiographic studies have suggested that arteries might still be patent in BD patients. Current clinical practices in BD diagnosis following S4VA need to be better understood.Methods:We conducted a retrospective study of all S4VA performed for the determination of BD in a level 1 NeuroTrauma centre from 2003 to 2007. The objective of the study was to describe the prevalence of intracranial arterial, capillary (parenchymogram) and venous opacification in our study population. All tests were reviewed independently by two neuroradiologists. Disagreements were resolved by consensus.Results:Thirty two patients were declared BD following S4VA during the study period. Nine of these patients (28%) presented some proximal opacification of intracranial arteries (95% CI 15-45%). As opposed, none had a cerebral capillary and deep venous drainage opacification (95% CI 0-10%).Conclusion:The absence of cerebral deep venous drainage or parenchymogram might represent a better objective marker of cerebral circulatory arrest for brain death diagnosis when the use of S4VA is required. These findings open the path for further research in enhancing our interpretation of angiographic studies for brain death diagnosis.

scholarly journals Implementation of Computed Tomography Angiography (CTA) and Computed Tomography Perfusion (CTP) in Polish Guidelines for Determination of Cerebral Circulatory Arrest (CCA) during Brain Death/Death by Neurological Criteria (BD/DNC) Diagnosis Procedure

2021 ◽  
Vol 10 (18) ◽  
pp. 4237
Author(s):  
Romuald Bohatyrewicz ◽  
Joanna Pastuszka ◽  
Wojciech Walas ◽  
Katarzyna Chamier-Cieminska ◽  
Wojciech Poncyljusz ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Brain Death ◽  
Computed Tomography Angiography ◽  
Cerebral Blood Volume ◽  
New Technologies ◽  
Circulatory Arrest ◽  
Brain Regions ◽  
National Guidelines ◽  
Computed Tomography Perfusion ◽  
Cerebral Circulatory Arrest

Background: Brain death/death by neurologic criteria (BD/DNC) guidelines are routinely analyzed, compared and updated in the majority of countries and are later implemented as national criteria. At the same time, extensive works have been conducted in order to unify clinical procedures and to validate and implement new technologies into a panel of ancillary tests. Recently evaluated computed tomography angiography and computed tomography perfusion (CTA/CTP) seem to be superior to traditionally used digital subtraction angiography (DSA), transcranial Doppler (TCD) and cerebral perfusion scintigraphy for diagnosis of cerebral circulatory arrest (CCA). In this narrative review, we would like to demonstrate scientific evidence supporting the implementation of CTA/CTP in Polish guidelines for BD/DNC diagnosis. Research and implementation process: In the first of our base studies concerning the potential usefulness of CTA/CTP for the confirmation of CCA during BD/DNC diagnosis procedures, we showed a sensitivity of 96.3% of CTA in a group of 82 patients. CTA was validated against DSA in this report. In the second study, CTA showed a sensitivity of 86% and CTP showed a sensitivity of 100% in a group of 50 patients. In this study, CTA and CTP were validated against clinical diagnosis of BD/DNC supported by TCD. Additionally, we propose our CCA criteria for CTP test, which are based on ascertainment of cerebral blood flow (CBF) < 10 mL/100 g/min and cerebral blood volume < 1 mL/100 g in regions of interest (ROIs) localized in all brain regions. Based on our research results, CTA/CTP methods were implemented in Polish BD/DNC criteria. To our knowledge, CTP was implemented for the first time in national guidelines. Conclusions: CTA and CTP-derived CTA might be in future the tests of choice for CCA diagnosis, proper and/or Doppler pretest might significantly increase sensitivity of CTA in CCA diagnosis procedures. Whole brain CTP might be decisive in some cases of inconclusive CTA. Implementation of CTA/CTP in the Polish BD/DNC diagnosis guidelines does not show any major obstacles. We believe that in next edition of “The World Brain Death Project” CTA and CTP will be recommended as ancillary tests of choice for CCA confirmation during BD/DNC diagnosis procedures.

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